THE COLLEGE OF EMERGENCY MEDICINE RCEM-EMUS...THE COLLEGE OF EMERGENCY MEDICINE ... 3 !

THE COLLEGE OF EMERGENCY

MEDICINE

Core (Level 1)

Ultrasound Curriculum

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2

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3

Ultrasound

physics+

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4

Pathology in relation to ultrasound+

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6

Assessment of the Abdominal Aorta competency+

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Vascular access competency

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8

2. Equipment - basics +

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9

Patient Information

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23

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nI#+,&+#B'?*,./)&,')%"V+$/%"+#,./+Y?.'*/+&1%)),)0+BD,1D+8'$.&+#D/+@%&,&+8'$+-./$0/)12+

3/*,1,)/+&1%)&V+&(1D+%&+EF9G+%)*+FFF+

nI)+>$%1#,1/V+(&/+#D/+D,0D/&#+8$/=(/)12+#D%#+%""'B&+%*/=(%#/+>/)/#$%#,')+#'+#D/+*/>#D+'8+

,)#/$/&#+

nI),#,%"+*/>#D+&/##,)0&+&D'("*+@/+&/#+#'+*/.')&#$%#/+%""+'8+#D/+$/"/W%)#+%)%#'.2V+)'#+](&#+#D/+

.'&#+&(>/$8,1,%"+&#$(1#($/&4+E($#D/$V+,),#,%"+*/>#D+&/##,)0&+&D'("*+@/+)'+*//>/$+#D%)+#D/+%$/%+

'8+,)#/$/&#+

nGD/+1,)/?"''>+8/%#($/+%""'B&+#D/+'>/$%#'$+#'+&1$'""+@%1A+#D$'(0D+&/W/$%"+&/1')*&+B'$#D+'8+

1%>#($/*+8$%./&+')1/+#D/+,.%0/+D%&+@//)+8$'g/)4+GD,&+,&+>%$#,1("%$"2+(&/8("+BD/)+,.%0,)0+

)')?1''>/$%#,W/+>%#,/)#&+

+

3.2 FAST

!"#$%&'()*+D%&+@//)+(&/*+,)+#D/+/%$"2+%&&/&&./)#+'8+%@*'.,)%"+#$%(.%+,)+1'()#$,/&+'(#&,*/+

#D/+!),#/*+^,)0*'.+8'$+#D/+>%&#+5;+2/%$&4+aW/$+#D/+"%&#+6H+2/%$&V+,)1$/%&,)0+/W,*/)1/+'8+#D/+

(#,",#2+'8+#D/+#/1D),=(/+D%&+@//)+>(@",&D/*V+%)*+,#+,&+)'B+B,*/"2+>$%1#,1/*6?H4+I#+D%&+#D/+

%*W%)#%0/+'8+@/,)0+)'),)W%&,W/V+$%>,*"2+>/$8'$./*+%)*+$/%*,"2+$/>/%#%@"/4+F"#D'(0D+

7D%.@/$&+/#+%"+>(@",&D/*+%+$/>'$#+,)+6<RR+')+(&/+'8+("#$%&'()*PV+#D/$/+D%&+@//)+",##"/+'#D/$+

/W,*/)1/+>(@",&D/*+8$'.+#D/+!^+()#,"+:;;;4++GD/$/+,&+0$'B,)0+,)#/$/&#+,)+("#$%&'()*+(&/+@2+

)')?$%*,'"'0,&#&+,)+#D,&+1'()#$2+B,#D+,)1$/%&,)0+%W%,"%@,",#2+'8+%88'$*%@"/+&2&#/.&V+%)*+W%$,'(&+

%(#D'$&+D%W,)0+>(@",&D/*+$/1/)#+/W%"(%#,')&+'8+#D/+#/1D),=(/+@2+%+&.%""+0$'(>+'8+

&')'0$%>D/$&+%.')0+#D/+#$%(.%+&#%88QVR4++

+

GD/+ >($>'&/+ '8+ ("#$%&'()*+ ,)+ #D/+ ,),#,%"+ %&&/&&./)#+ '8+ %@*'.,)%"+ #$%(.%V+ ,&+ &'"/"2+ #'+

*'1(./)#+#D/+>$/&/)1/+'8+8$//+ ,)#$%>/$,#')/%"+8"(,*4+ + + I)+#D/+1')#/T#+'8+#$%(.%+#D,&+8"(,*+ ,&+

%&&(./*+#'+@/+@"''*+@(#+#D,&+.%2+)'#+%1#(%""2+@/+#D/+1%&/4+GD/$/+,&+)'+%##/.>#+#'+W,&(%",&/+

&>/1,8,1+'$0%)+,)]($,/&V+%&+("#$%&'()*+,&+)'#+%11($%#/+,)+#D/+/%$"2+%&&/&&./)#+'8+&'",*+'$0%)+'$+

D'""'B+ W,&1(&+ ,)]($2<4+ + GD/+%@&/)1/+'8+ 8$//+ 8"(,*+*'/&+ )'#+ /T1"(*/+ &/$,'(&+ ,)#$%?%@*'.,)%"+

,)]($24++

+

E($#D/$+ .%)%0/./)#+ ,&+ *,1#%#/*+ @2+ #D/+ 1",),1%"+ 1')*,#,')+ '8+ #D/+ >%#,/)#4+ !"#$%&'()*+ ,&+

*/&,0)/*+#'+1'.>"/./)#+'#D/$+,)W/&#,0%#,')&+&(1D+%&+`,%0)'&#,1+C/$,#')/%"+M%W%0/+N`CMOV+

BD,1D+ ,&+ W/$2+ &/)&,#,W/+ @(#+ )'#+B,#D'(#+ *,&%*W%)#%0/&4+ \'B/W/$V+ 7'.>(#/*+ G'.'0$%>D2+

N7GO+$/.%,)&+#D/+0'"*+&#%)*%$*4++

+

GD/+ 8%1#+ #D%#+ #D/$/+ ,&+ (&(%""2+ &'./+*/"%2+ ,)+'@#%,),)0+%+7G+ &1%)V+%)*+ #$%)&8/$+'(#+'8+ #D/+

*/>%$#./)#+)/1/&&,#%#/&+%+D%/.'*2)%.,1%""2+&#%@"/+>%#,/)#V+./%)&+#D%#+("#$%&'()*+,)+#D/+

$/&(&1,#%#,')+$''.+@/1'./&+W/$2+(&/8("+,)+$%>,*+*,%0)'&,&4++

Key point: Ultrasound complements other investigations, and CT remains the gold standard

to detect intra-abdominal injury.

25

E'1(&/*+F&&/&&./)#+B,#D+9')'0$%>D2+,)+G$%(.%+NEF9GO+D%&+"%$0/"2+$/>"%1/*+`CM+BD,1DV+

BD,"/+&/)&,#,W/V+,&+$/0%$*/*+%&+,)W%&,W/V+1'.>$'.,&,)0+'#D/$+,)W/&#,0%#,')&+%)*+#,./+

1')&(.,)04+GD/+%*W%)#%0/+'8+EF9G+,&+#D%#+,#+1%)+@/+$/>/%#/*+%&+.%)2+#,./&+%&+)/1/&&%$24+

I#+1%)+@/+1%$$,/*+'(#+*($,)0+1",),1%"+%&&/&&./)#V+B,#D,)+.,)(#/&+'8+#D/+>%#,/)#+%$$,W,)0+%)*+

@/8'$/+%)2+'#D/$+,)W/&#,0%#,')V+&(1D+%&+7GV+1%)+@/+'$0%),g/*4+I#+1%)+%"&'+@/+1%$$,/*+'(#+')+

%)+()&#%@"/+>%#,/)#+BD/$/+%+7G+$/=(,$/&+#D/+>%#,/)#+#'+@/+&#%@"/4++++++

+

F&+,)+.'&#+%&>/1#&+'8+)')?$%*,'"'0,&#+("#$%&'()*+,#+&D'("*+@/+'>/$%#/*+')+%+j$("/+,)eV+)'#+%+

$("/+'(#+>$,)1,>"/V+,4/4+#D/$/+,&+)'+&(1D+#D,)0+%&+%+)'$.%"+EF9G4+GD,&+,&+,.>'$#%)#+BD/)+

1'..(),1%#,)0+8,)*,)0&+#'+1'""/%0(/&4+I#+,&+%>>$'>$,%#/+#'+&%2+#D%#+8$//+8"(,*+D%&+)'#+@//)+

&//)V+@(#+#D,&+&D'("*+@/+=(%",8,/*+@2+#D/+&#%#/./)#+#D%#+#D,&+*'/&+)'#+./%)+#D%#+@"//*,)0+,&+

)'#+'11($$,)04+

+

S/W,/B+'8+>(@",&D/*+",#/$%#($/+&D'B&+#D%#+#D/$/+,&+)'+%0$//*+#$%,),)0+&1D/*("/V+B,#D+

>$'0$%../&+W%$2,)0+B,*/"2V+8$'.+')/+D'($+"/1#($/+%)*+')/+D'($+>$%1#,1%"+#$%,),)0V+#'+'W/$+

H;;+&(>/$W,&/*+&1%)&46;?6:++9D%1A8'$*+/#+%"+&(00/&#/*+#D%#+#D/+/$$'$+$%#/+&#%@,",&/*+%8#/$+#/)+

&1%)&465+C(@",&D/*+*%#%+$/W/%"&+#D%#+EF9G+1%$$,/*+'(#+@2+/./$0/)12+>D2&,1,%)&V+D%&+%+

&>/1,8,1,#2+@/#B//)+<HU6;;o+%)*+%+&/)&,#,W,#2+'8+P<U<Ro4+I#+,&+1"/%$"2+W/$2+'>/$%#'$+

*/>/)*%)#4++

+

Y$%))/2+ /#+ %"6K+*/.')&#$%#/*+ #D%#+ &.%""+ =(%)#,#,/&+ '8+ 8"(,*+ N%&+ &.%""+ %&+ ::H+ ."O+ 1%)+ @/+

*/#/1#/*V+ @(#+ RHo+ '8+ &')'0$%>D/$&+ B,""+ @/+ */#/1#,)0+ RH;+ ."4+ GD/$/8'$/V+ ,)+ $/0%$*+ #'+

*/#/1#,)0+8$//+8"(,*V+#D/$/+B%&+)'+*,88/$/)1/+@/#B//)+/./$0/)12+>D2&,1,%)&V+&($0/')&+'$+

$%*,'"'0,&#&4+

+

The Standard FAST Views

`($,)0+#D/+6<<;e&V+&,T+EF9G+W,/B&+B/$/+*/&1$,@/*+#'+

,)1"(*/+ #B'+>%$%1'",1+ W,/B&V+@(#+ #D/&/+>%$%1'",1+

W,/B&+ D%W/+ 0/)/$%""2+ @//)+ *$'>>/*4+ 3'$/+

$/1/)#"2V+ /T#/)*/*+ EF9G+ NA)'B)+ %&+ -EF9GO+ ,&+

0%,),)0+>'>("%$,#24+GD,&+,)1"(*/&+%)+(>>/$+#D'$%1,1+

W,/B+ '8+ #D/+ $,0D#+ %)*+ "/8#+ "()0+ 8,/"*&V+ #'+ "''A+ 8'$+

&,0)&+'8+>)/(.'#D'$%T4+-EF9G+,&+)'#+>%$#+'8+M/W/"+6+

#$%,),)0V+ %"#D'(0D+ #D/+ (>>/$+ #D'$%1,1+ W,/B&+ %$/+

$/%*,"2+ "/%$)/*+ "%#/$4+ + E($#D/$.'$/V+ F7-9+

NF@*'.,)%"+ %)*+ 7%$*,%1+ -W%"(%#,')+ B,#D+

9')'0$%>D2+ ,)+ 9D'1AO+ 1'.@,)/&+ IJ7+ W,&(%",&%#,')+

%)*+%+W,/B+'8+#D/+.2'1%$*,(.+#'0/#D/$+B,#D+FFF+

%)*+ EF9GV+ %)*+ #D,&+ ,&+ %"&'+ 0%,),)0+ %+ >"%1/+ ,)+

7$,#,1%"+7%$/+!"#$%&'()*4+

+

+

+

26

GD/+&#%)*%$*+EF9G+W,/B&+%$/+%&+",&#/*+@/"'B_++

+

! GD/+$,0D#+(>>/$+=(%*$%)#+NS!kOV+#'+,)1"(*/+3'$,&')e&++>'(1D+

%)*+#D/+$,0D#+1'&#'?>D$/),1+>"/($%"+$/1/&&++

+

+

+

+

+

+

+

+

! GD/+"/8#+(>>/$+=(%*$%)#+NM!kOV+#'+,)1"(*/+#D/+&>"/)'?$/)%"+$/1/&&+

%)*+#D/+"/8#+1'&#'?>D$/),1+>"/($%"+$/1/&&++

+

+

+

+

+

+

+

+

+

+

! GD/+>/$,1%$*,%"+&%1V+8$'.+@/"'B+'$+#$%)&#D'$%1,1++

+

+

+

+

+

+

+

+

+

! GD/+>/"W,1+1%W,#2V+,)+#B'+>"%)/&+

+

27

Positioning the Probe – RUQ and LUQ Views

I.%0,)/+ #D/+>$'@/+ ,&+%+ #'$1D+%)*+ ,.%0,)/+ &D,),)0+ ,#+ #'B%$*&+ #D/+ ,)#/$)%"+%$/%+BD,1D+2'(+

B%)#+#'+&//4+E'$+#D/+S!k+W,/BV+&#%$#+')+#D/+$,0D#+&,*/+%)*+&,#/+#D/+>$'@/+](&#+%)#/$,'$+#'+#D/+

.,*?%T,""%$2+",)/V+%)0"/*+%)*+&",0D#"2+@%1AB%$*&V+#'+"''A+%#+#D/+%)#/$,'$+%&>/1#+'8+#D/+$/)%"+

1%>&("/4++

+

GD/+M!k+W,/B+,&+%+",##"/+.'$/+*,88,1("#+#'+'@#%,)+%&+#D/+"/8#+A,*)/2+,&+D,0D/$+#D%)+#D/+$,0D#V+%)*+

#D/$/8'$/+ #D/+W,/B+ #D$'(0D+%)+ ,)#/$1'&#%"+B,)*'B+.%2+)//*+ #'+@/+'@#%,)/*4+ 9,#/+

#D/+>$'@/+ ](&#+>'&#/$,'$+ #'+ #D/+.,*?%T,""%$2+ ",)/V+%)0"/*+%)*+ &",0D#"2+@%1AB%$*&V+ #'+

"''A+%#+#D/+%)#/$,'$+%&>/1#+'8+#D/+$/)%"+1%>&("/4

Key point: For RUQ and LUQ views, start at the mid-axillary line and angle the probe slightly

backwards: the LUQ probe position is always slightly more towards the axilla.

E'$+#D/+>/$,1%$*,%"+W,/BV+#$2+#D/+&(@?T2>D',*+%>>$'%1D+8,$&#4+F"#/$)%#,W/"2V+#D/+>%$%&#/$)%"+

W,/B+.%2+@/+@/##/$4+I)+#D,&+,)&#%)1/V+#D/+.%$A/$+&D'("*+>',)#+*'B)+#'+#D/+D/%$#+%>/T+#'+

0%,)+%+&#%)*%$*+W,/B4++

+

E'$+#D/+>/"W,&+&%0,##%"+W,/BV+>'&,#,')+#D/+>$'@/+%&+&D'B)4+F+#$%)&W/$&/+W,/B+&D'("*+%"&'+@/+

'@#%,)/*4++

+

Key point: The marker on the probe should always be orientated towards the patient’s

head, or to their right (except in the long axis parasternal view).

+

28

a)/+'8+#D/+>$%1#,1%"+1')&,*/$%#,')&+,)+EF9G+,.%0/+%1=(,&,#,')+,&+.'W,)0+#D/+>%#,/)#e&+%$.&V+

>%$#,1("%$"2+BD/)+#D/+1'#+&,*/&+%$/+/"/W%#/*4+a@W,'(&"2+#D,&+1%)+@/+*,88,1("#+,)+%+$/&(&1,#%#,')+

&/##,)04++

Interpretation

E$//+ 8"(,*+ "''A&+ @"%1AV+ @'#D+ ,)+ #D/+ >/$,#')/%"+ 1%W,#2+ %)*+ >"/($%"+ $/1/&&4+ -%$"2+ >/$,#')/%"+

1'""/1#,')&+%$/+&//)+](&#+%)#/$,'$+#'+#D/+$/)%"+1%>&("/+%)*+%>>/%$+%&+%+@"%1A+&#$,>/4++

+

9.%""+ >"/($%"+ 1'""/1#,')&+ @/0,)+ #'+

%11(.("%#/+ >'&#/$,'$"2V+ #D/$/8'$/+ .%2+

)'#+ @/+ &//)+ *($,)0+ %+ EF9G+ &1%)4+ I)+ #D/+

,.%0/+ &D'B)+ #D/+ EF9G+ %>>/%$%)1/&+

B/$/+)'$.%"+@(#+#D/+7G+$/W/%"/*+%+&.%""+

"/8#+D%/.'#D'$%T4++

+

I8+ )'+ 8$//+ 8"(,*+ ,&+ &//)+ 1')&,*/$+ %+ $/>/%#+

&1%)V+ >/$D%>&+ 6;+.,)(#/&+ "%#/$4+ I8+ %#+ %)2+

&#%0/+ %+ @"%1A+ ",)/+ %)#/$,'$+ #'+ #D/+ $/)%"+

1%>&("/V+ '$+ @"%1A+ %$/%+ ,)+ #D/+ >"/($%"+

$/1/&&+,&+>$/&/)#V+#D/+,)#/$>$/#%#,')+&D'("*+

@/+ #D%#+ #D/$/+ ,&+ 8$//+ 8"(,*+ >$/&/)#4+ Y/+

1%(#,'(&+ ,)+ .%A,)0+ #D/+ %&&(.>#,')+ #D%#+

#D,&+,&+@"''*+?+%&+>$/W,'(&"2+$/8/$$/*+#'4+

+

+

+

+

+

+

Image Appearances - Right Upper

Quadrant

GD/+ S!k+ ,&+ #D/+%$/%+ #'+ &1%)+ 8,$&#V+ %&+ 8$//+

8"(,*+B,""+'8#/)+@/+&//)+ ,)+#D,&+%$/%+/%$",/$+

#D%)+ ,)+ '#D/$+ %$/%&+ N%&+ &D'B)O4+ I)+

%**,#,')V+#D,&+ ,&+>$'@%@"2+#D/+/%&,/&#+%$/%+

#'+&1%)+%)*+,)+BD,1D+#'+0%,)+1')8,*/)1/4+

-)&($/+ #D/+ >"/($%"+ $/1/&&+ ,&+ %*/=(%#/"2+

&//)4++++

Key point: The RUQ is the area where free

fluid is likely to be detected first.

29

Image Appearances - Left Upper Quadrant

GD/+ M!k+ ,&+ #D/+ %$/%+ #'+ &1%)+ )/T#4+ C'&,#,')+

#D/+>$'@/+%&+&D'B)+,)+#D/+*,%0$%.V+&",0D#"2+

1"'&/$+#'+#D/+%T,""%+#D%)+8'$+#D/+S!k+W,/B4++

Key point: The LUQ view requires the probe

to be slightly higher, i.e. toward the axilla,

than the RUQ view.

+

Image Appearances - Pleura

GD/+>"/($%"+ &>%1/+1%)+@/+W,&(%",g/*+ ,)+ #D/+S!k+

%)*+ M!k+ W,/B&4+ + C"/($%"+ N%)*+>/$,#')/%"O+ 8"(,*+ ,&+

&D'B)+D/$/+,)+#D/+S!k+W,/B4+

+

Image Appearances - Pericardium

GD/+ >/$,1%$*,(.+ 1%)+ @/+ W,&(%",&/*+ &(@?

T,>D,&#/$)%""2+'$+>%$%&#/$)%""24+ I#+ ,&+/%&,/$+ #'+1%$$2+

#D,&+ '(#+ (&,)0+ %+ >%$%&#/$)%"+ W,/B+ ,)+ #D/+ "/8#+

>%$%&#/$)%"+ %$/%4+ GD/+ &/##,)0&+ )//*+ #'+ @/+

1D%)0/*+ #'+ ",.,#+ #D/+ W,/B+ #'+ #D/+ %$/%+ @/,)0+

/T%.,)/*4+ X,#D+ .'$/+ %*W%)1/*+ >$%1#,1/V+ #D/+

/./$0/)12+&')'0$%>D/$+B,""+ "/%$)+#'+"''A+%#+#D/+

@%1A+'8+ #D/+>'&#/$,'$+%&>/1#&+'8+ #D/+>/$,1%$*,%"+

&%1+ %)*+ )'#+ %#+ #D/+ %)#/$,'$+ %&>/1#&V+ %&+ ,)+ %+

&(>,)/+>%#,/)#+#D,&+,&+BD/$/+8"(,*+B,""+@/0,)+#'+>''"+

/%$",/$4+ + I)+ #D,&+ %>,1%"+ W,/B+ #D/$/+ ,&+ >/$,1%$*,%"+

8"(,*+>$/&/)#4+++

Key point: Pericardial collections will be seen

posteriorly at first.

30

+

Image Appearances - Pelvic Cavity

GD/+>/"W,1+1%W,#2+,&+%+.'$/+*,88,1("#+%$/%+#'+&1%)+

%)*+#%A/&+/T>/$,/)1/4+GD/+#2>,1%"+%>>/%$%)1/+

'8+&.%""+@'B/"+"''>&+8"'%#,)0+,)+8"(,*+,&+&D'B)V+@(#+

.(1D+&.%""/$+W'"(./&+'8+8"(,*+,)+#D/+$/#$'W/&,1%"+

>'(1D+,)+#D/+.%"/V+'$+#D/+>'(1D+'8+`'(0"%&+,)+

#D/+8/.%"/V+1%)+@/+*,%0)'&#,14+GD/+#/1D),=(/+

8'$+&/"/1#,)0+#D/&/+%$/%&+)//*&+#'+@/+.%&#/$/*+

,)+%+>$%1#,1%"+&/&&,')4+F+&.%""+%.'()#+'8+8"(,*+,)+

#D/+>'(1D+'8+`'(0"%&V+,)+#D/+8/.%"/+>/"W,&V+.%2+

@/+)'$.%"+8'""'B,)0+'W("%#,')4++

Key point: Don’t assume free fluid is blood.

Algorithm for FAST

EF9G+,&+)'+&(@&#,#(#/+8'$+7G+%)*+%+.'$/+*/8,),#,W/+%&&/&&./)#+'8+#D/+>%#,/)#+,&+'@#%,)/*+B,#D+

7G4+ I)*//*+ %+ >'&,#,W/+ EF9G+

&1%)+,)+%+&#%@"/+>%#,/)#+&D'("*+

%"B%2&+"/%*+#'+%+7G+&1%)4+GD,&+

*/8,)/&+ B,#D+ >$/1,&,')+ BD/$/+

#D/+ >%#D'"'02+ ,&+ B,#D,)+ #D/+

>/$,#')/%"+ 1%W,#2V+ %)*+

8($),&D/&+ #D/+ &($0/')+ B,#D+ %&+

.(1D+ ,)8'$.%#,')+%&+>'&&,@"/4+++

F+>'&,#,W/+&1%)+,)+%)+()&#%@"/+

>%#,/)#+ .%2+ $/&("#+ ,)+ #D/+

&($0/')+ 8//",)0+ #D%#+

,../*,%#/+ "%>%$'#'.2+ ,&+

%>>$'>$,%#/4+ GD,&+ */>/)*&+ ')+

#D/+/T>/$,/)1/+'8+#D/+&($0/')+

%)*+ %+ */0$//+ '8+ 1')8,*/)1/+

#D%#+ #D/+ 8"(,*+ ,&+ )'#+ *(/+ #'+

>/"W,1+W/)'(&+@"//*,)04+

+

31

Using FAST skills for Echocardiography in Life

Support (ELS) –see section 3.5

-1D'1%$*,'0$%>D2+ ,)+ M,8/+9(>>'$#+ N-M9O+ ,&+ "/%$)/*+

%"')0&,*/+EF9G4++ I#+$/=(,$/&+1%$/8("+#,.,)0+B,#D+#D/+

$D2#D.+1D/1A4+`($,)0+ #D,&+ 6;?&/1')*+B,)*'B+ #D/+

>$'@/+ ,&+ '8#/)+ &/#+ #'+ .%T,.(.+ */>#D+ %)*+

,)1$/%&/*+ 0%,)V+ #'+ ,)1$/%&/+ #D/+ ",A/",D''*+ '8+

"'1%#,)0+#D/+D/%$#+$%>,*"24+ I8+ #D/+D/%$#+1%))'#+@/+

&//)+*($,)0+ #D/+ $D2#D.+1D/1AV+ #D/+>$'@/+ &D'("*+

@/+ $/.'W/*+ %#+ 6;+ &/1')*&+ %)*+ 7CS+

$/1'../)1/*4++

+

GD/+ #/1D),=(/+ '8+ -1D'1%$*,'0$%>D2+ ,)+ M,8/+

9(>>'$#+ N-M9OV+ .%2+ @/+ 1%$$,/*+ '(#+ B,#D+ #D/+

>$'@/+,)+#D/+&(@?T,>D',*+>'&,#,')V+@(#V+,)+8%1#+

#D,&+ W,/B+ ,&+ '8#/)+ )'#+ &%#,&8%1#'$2V+ %)*+ %+

&B,#1D+ #'+ #D/+>%$%&#/$)%"+ "')0+%T,&+W,/B+1%)+

0,W/+@/##/$+W,/B&V+%)*+,&+/%&,/$+#'+1%$$2+'(#4+

Key point: ELS has two priorities, to assess

cardiac movement and to identify

remediable pathology.

I)+-M9+#D/$/+%$/+#B'+>$,'$,#,/&V+)%./"2_+

(i) to assess cardiac movement and (ii) to identify remediable pathology

+

I)+%&&/&&,)0+1%$*,%1+.'W/./)#V+#D$//+>'&&,@,",#,/&+/T,&#_+

64GD/$/+ ,&+ )'+ 1%$*,%1+ .'W/./)#4+ I8+ #D/+ D/%$#+ ,&+ &//)+ #'+ @/+ .'#,')"/&&+ %)*+ #D,&+

1'$$/&>')*&+ B,#D+ %&2&#'"/+ ')+ #D/+.'),#'$V+ &($W,W%"+ ,&+ D,0D"2+ ()",A/"24+ I*/)#,82,)0+ #D,&+

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:4GD/$/+,&+1%$*,%1+.'W/./)#+B,#D+&,)(&+$D2#D.+')+#D/+.'),#'$4+I8+#D/+1%$'#,*+>("&/+,&+

%@&/)#V+ #D/+ >%#,/)#+ D%&+ %+ 1')*,#,')+ A)'B)+ %&+ j>&/(*'?C-Fe+ ,)+ BD,1D+ #D/$/+ ,&+

./1D%),1%"+%1#,')+'8+#D/+D/%$#V+@(#+'8+,)&(88,1,/)#+.%0),#(*/+#'+0/)/$%#/+%+>("&/4N6HO+

GD/+ ,.>'$#%)1/+'8+ ,*/)#,82,)0+ #D,&+ 1')*,#,')+ ,&+ #D%#+ &($W,W%"+ ,&+.(1D+ D,0D/$+ ,)+ #D/&/+

>%#,/)#&4N6PO+

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8'()*+ #'+ D%W/+ JE+ ')+ /1D'1%$*,'0$%>D24N6QO+ 9(1D+ >%#,/)#&+ '@W,'(&"2+ $/=(,$/+

1%$*,'W/$&,')4+

32

GD/+#B'+.%,)+1')*,#,')&+#D%#+.%2+$/&>')*+#'+,../*,%#/+#$/%#./)#+%$/_+

+

nC/$,1%$*,%"+/88(&,')+&(88,1,/)#"2+"%$0/+#'+1%(&/+#%.>')%*/4++G%.>')%*/+,&+%+>D2&,'"'0,1%"+

*,%0)'&,&+#D%#+,&+W,$#(%""2+,.>'&&,@"/+#'+.%A/+*($,)0+1%$*,%1+%$$/&#+B,#D'(#+#D/+(&/+'8+/1D'4+I8+

%+ "%$0/+ /88(&,')+ ,&+ ,*/)#,8,/*V+ #D,&+ )//*&+ #'+ @/+ >(#+ ,)#'+ 1')#/T#+ B,#D+ #D/+ 'W/$%""+ 1",),1%"+

&,#(%#,')V+@(#+>/$,1%$*,'1/)#/&,&+.(&#+@/+1')&,*/$/*4+

+

n3%&&,W/+ >(".')%$2+ /.'@",&.+ NC-O4+ E/%#($/&+ '8+ .%&&,W/+ C-+ ,)1"(*/+ >$/&/)1/+ '8+ W,&,@"/+

#D$'.@(&+,)+#D/+D/%$#V+%+$,0D#+W/)#$,1"/+*,%./#/$+#'+"/8#+W/)#$,1"/+*,%./#/$+$%#,'+0$/%#/$+#D%)+

')/V+ %)*+ %+ *,"%#/*+ ,)8/$,'$+ W/)%+ 1%W%+ N&//+ #D/+ &/&&,')+ 9'8#+ G,&&(/+ 3(&1("'&A/"/#%"+ d+

!"#$%&'()*+d+9A,""&+'8+7%$$2,)0+a(#+F&&/&&./)#+E'$+F@*'.,)%"+F'$#,1+F)/($2&.O4+I8+.%&&,W/+C-+

,&+&#$')0"2+&(&>/1#/*V+%>>$'>$,%#/+%1#,')+&D'("*+@/+#%A/)+N/404+#D$'.@'"2&,&O4+

+

3.3 Assessment of the Abdominal Aorta and IVC

!"#$%&'()*+,&+$'(#,)/"2+(&/*+8'$+#D/+

&1$//),)0+%)*+.'),#'$,)0+'8+%'$#,1+

*,%./#/$V+%)*+%+",.,#/*+("#$%&'()*+

&1%)+1%)+$/",%@"2+$/1'$*+#D/+>$/&/)1/+

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%@*'.,)%"+%'$#,1+%)/($2&.&+NFFFO+

%$/+1')8,)/*+#'+#D/+,)8$%$/)%"+%'$#%4+

GD/+$,&A+'8+$(>#($/+B,#D,)+H+2/%$&+,&+:H+o+

%#+H+1.+*,%./#/$4+FFF+&.%""/$+#D%)+H+

1.+D%W/+%+5+o+$,&A+'8+$(>#($/+'W/$+6;+

2/%$&4+I)+#D/+%1(#/+&/##,)0+%)+FFF+,&+

*/8,)/*+%&+%+#$%)&W/$&/+%'$#,1+

*,%./#/$+0$/%#/$+#D%)+5+1.4+

+

GD/+$'"/+'8+("#$%&'()*+,&+#'+*/#/1#+%)+

/)"%$0/*+%@*'.,)%"+%'$#%+%#+#D/+

/%$",/&#+1",),1%"+'>>'$#(),#24+I8+%+)'$.%"+

%'$#%+,&+1"/%$"2+&//)+%"')0+,#&+8(""+

/T#/)#+#D/)+%)+%'$#,1+%)/($2&.+1%)+@/+/T1"(*/*4++\'B/W/$V+,#+.(&#+%"B%2&+@/+@'$)/+,)+

.,)*+#D%#+#D/$/+%$/+'#D/$V+.'$/+$%$/+%)/($2&.&V+/404+&>"/),1+%$#/$24++GD/+(&/+'8+("#$%&'()*+

@2+/./$0/)12+>D2&,1,%)&+,&+@/1'.,)0+,)1$/%&,)0"2+>'>("%$+,)+#D/+!^4+GD/+,../*,%12+%)*+

%W%,"%@,",#2+'8+@/*&,*/+("#$%&'()*+,)+#D/+-./$0/)12+`/>%$#./)#+./%)&+#D%#+1$,#,1%"+

.%)%0/./)#+*/1,&,')&+1%)+@/+.%*/+/%$",/$4++

+

F&+#D/+1",),1%"+%&&/&&./)#+'8+#D/+%@*'.,)%"+%'$#%+8'$+FFF+D%&+&D'B)+#'+@/+()$/",%@"/6HV+

')/+'8+#D/+A/2+$'"/&V+,*/)#,8,/*+,)#/$)%#,')%""2+8'$+/./$0/)12+>D2&,1,%)+>/$8'$./*+

("#$%&'()*V+,&+/%$"2+,*/)#,8,1%#,')+'8+%@*'.,)%"+%'$#,1+%)/($2&.&+NFFFO4+I)#/$)%#,')%""2V+

&#(*,/&+D%W/+*/.')&#$%#/*+#D%#+/./$0/)12+>D2&,1,%)&+1%)+%11($%#/"2+>/$8'$.+%'$#,1+

("#$%&'()*+&1%)&+B,#D+$/"%#,W/"2+",##"/+#$%,),)046PU6<++

+

I)+#D/+/./$0/)12+&/##,)0+,#+,&+(&(%""2+*,88,1("#+#'+*/8,)/+#D/+",.,#&+'$+$/"%#,')&+'8+#D/+%)/($2&.V+

&'+B/+B'("*+(&(%""2+1')1/)#$%#/+')+#D/+&,)0"/+,&&(/+'8+BD/#D/$+,#+,&+%)/($2&.%"+'$+)'#4++

9,.,"%$"2V+("#$%&'()*+,&+)'#+%11($%#/+,)+*/#/$.,),)0+#D/+>$/&/)1/+'8+%+"/%A+8$'.+#D/+

33

%)/($2&.4+F0%,)+B/+1')1/)#$%#/+')+BD/#D/$+%)/($2&.%"+1D%)0/+,&+>$/&/)#+'$+)'#4++GD/+

1($$/)#+/W,*/)1/+8'$+#D/+*,%0)'&#,1+%@,",#2+'8+/./$0/)12+>D2&,1,%)+("#$%&'()*V+8'$+

*/#/1#,')+'8+FFFV+,&+@%&/*+')+%+)(.@/$+'8+,)#/$)%#,')%"+&.%""+1'D'$#+&#(*,/&46P?6<+GD/&/+

&/$,/&+$/>'$#+D,0D+&/)&,#,W,#,/&+N<KU6;;+oO+%)*+&>/1,8,1,#,/&+N<RU6;;+oO4+

+

!^+/./$0/)12+>D2&,1,%)&+1%)+

%11($%#/"2+%)*+(&/8(""2+()*/$#%A/+

/./$0/)12+("#$%&'()*+&1%)&+#'+

*/#/1#+FFFV+B,#D+%+&/)&,#,W,#2+

1'.>%$%@"/+#'+#D%#+'@#%,)/*+

,)#/$)%#,')%""24++-./$0/)12+

("#$%&'()*V+>/$8'$./*+@2+!^+

/./$0/)12+>D2&,1,%)&V+D%&+@//)+

$/>'$#/*+%&+D%W,)0+#D/+8'""'B,)0+

%11($%12+>$'8,"/+8'$+#D/+*/#/1#,')+'8+

FFF:;_+++

n9/)&,#,W,#2+'8+<P45+o+N<H+o+

1')8,*/)1/+,)#/$W%"+N7IOV+R64;+o+#'+

<<4<+oO+

n9>/1,8,1,#2+'8+6;;+o+N<H+o+7IV+<64R+o+

#'+6;;+oO+

nc/0%#,W/+>$/*,1#,W/+W%"(/+'8+<R4P+o+

N<H+o+7IV+RR4;+o+#'+<<4<+oO+

nC'&,#,W/+>$/*,1#,W/+W%"(/+'8+6;;+o+N<H+o+7IV+RP4R+o+#'+6;;+oO+

+Y/)/8,#&+%>>/%$+1')&,*/$%@"/4+9,/$g/)&A,e&+B'$A::+,)*,1%#/&+#D%#+/./$0/)12+>D2&,1,%)+

("#$%&'()*+*/1$/%&/&+#D/+#,./+#'+*,%0)'&,&+,)+$(>#($/*+FFF4++GD/+./%)+#,./+'8+6R;+.,)(#/&+

B%&+$/*(1/*+#'+R;+.,)(#/&4+I)+%**,#,')V+#D/+#,./+#'+7G+&1%)+,&+%"&'+$/*(1/*V+%&+,&+#D/+#,./+#'+

'>/$%#,W/+$/>%,$4+

+

-./$0/)12+3/*,1,)/+FFF+%&&/&&./)#+,&+%+8'1(&/*+/T%.,)%#,')+#'+%)&B/$+%+&,)0"/+1",),1%"+

=(/&#,')V+,4/4+“Is an abdominal aortic aneurysm (with a diameter greater than 3cm)

present?”+

F&+,)+%""+%$/%&+'8+-./$0/)12+3/*,1,)/+("#$%&'()*+B/+j$("/+,)e+>%#D'"'02+$%#D/$+#D%)+$("/+,#+

'(#4+\%W,)0+&%,*+#D,&V+,8+#D/+/)#,$/+%'$#%+,&+1')8,*/)#"2+&//)V+%)+FFF+B,""+)'#+@/+>$/&/)#4++GD/+

1'.@,)%#,')+'8+%)+%)/($2&.+')+("#$%&'()*V+%)*+%)+()&#%@"/+'$+&2.>#'.%#,1+>%#,/)#V+,&+

/)'(0D+#'+B%$$%)#+%)+/./$0/)12+W%&1("%$+&($0/$2+'>,),')4++

34

F'$#,1+%)/($2&.+,&+.'$/+>$/W%"/)#+,)+/"*/$"2+./)+N.%"/_8/.%"/+$%#,'+,&+K_6OV+%)*+#D/+

,)1,*/)1/+D%&+@//)+/&#,.%#/*+%#+66+o+,)+./)+'W/$+PH4:5++I#+,&+$/"%#/*+#'V+%)*+#D/$/8'$/+.%2+

1'?/T,&#+B,#DV+'#D/$+%#D/$'.%#'(&+*,&/%&/&V+&(1D+%&+.2'1%$*,%"+,)8%$1#,')V+&#$'A/+%)*+

./&/)#/$,1+,&1D%/.,%4++I#+D%&+@//)+

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$(>#($/*+%'$#,1+%)/($2&.+,)+#D/+

1'..(),#2V+')"2+%@'(#+H;+o+B,""+

$/%1D+D'&>,#%"+%",W/4+E($#D/$.'$/V+

#D/+5;?*%2+.'$#%",#2+$%#/+'8+#D'&/+

B,#D+%+$(>#($/*+%)/($2&.+BD'+$/%1D+

&($0/$2V+,&+%"&'+%>>$'T,.%#/"2+H;+o4+++

F&+%+$/&("#V+&D'$#?#/$.+&($W,W%"+%8#/$+%+

$(>#($/*+FFF+,&+6+,)+KV+BD/$/%&+

.'$#%",#2+8'""'B,)0+/"/1#,W/+&($0/$2+,&+

"/&&+#D%)+H+o4+`/#/1#,)0+%+=(,/&1/)#+

%'$#,1+%)/($2&.+,)+#D/+/./$0/)12+

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",8/&%W,)04+

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%'$#%+%$/+@'#D+&//)+,)+.'&#+1%&/&V+

%&+,)+#D,&+("#$%&'()*+&1%)4+I#+,&+

>'&&,@"/+8'$+%+)'W,1/+#'+1')8(&/+#D/+

#B'4++

+

GD/+%'$#%+,&+&,#(%#/*+%)#/$,'$+#'+#D/+

W/$#/@$%"+@'*,/&+%)*+"/8#+'8+.,*",)/V+BD/$/%&+#D/+IJ7+",/&+#'+#D/+$,0D#+'8+.,*",)/4+GD/+%'$#%+

#%>/$&+%)*+#/)*&+#'+@/+#'$#('(&+%)*+.'W/+#'+#D/+"/8#4+I#+1%)+@/+1%"1,8,/*+%)#/$,'$"2+BD,1D+

1%)+.%A/+#D/+("#$%&'()*+W,/B+.'$/+*,88,1("#4+

+

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nS,0D#+&,*/+

nGD,)+B%""/*+

n7'.>$/&&,@"/+

nG$%)&.,##/*+>("&/+Nj*'(@"/+@'()1/eO+

nF".')*+&D%>/*+N9D%>/+W%$,/&O+

+

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nM/8#+&,*/+

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nX,""+)'#+1'.>$/&&+

nC("&%#,"/+

nS'()*+,)+&D%>/+

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n9(>/$,'$+./&/)#/$,1+%$#/$2+N93FO+*/.')&#$%#/*+

35

Y/8'$/+&#%$#,)0+#'+&1%)+#D/+%'$#%V+,#+,&+D/">8("+

#'+()*/$&#%)*+#D/+%)%#'.2V+BD,1D+,&+&D'B)+

,)+#D/+,.%0/4++c'#/+#D/+@$%)1D/&+'8+#D/+

1'/",%1+%T,&+%)*+,#&+$/"%#,')&D,>+#'+#D/+

&(>/$,'$+./&/)#/$,1+%$#/$2+N93FO4+

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*,%>D$%0.V+#D/+&(>/$,'$+./&/)#/$,1+%$#/$2+,&+

:+1.+@/"'B+#D/+1'/",%1+%T,&V+#D/+,)8/$,'$+

./&/)#/$,1+%$#/$2+,&+K+1.+%@'W/+#D/+

@,8($1%#,')V+#D/+%'$#%+@,8($1%#/&+%#V+'$+

,../*,%#/"2+@/"'BV+#D/+(.@,",1(&+NMKOV+#D/+

.%T,.(.+/T#/$)%"+*,%./#/$+N./%&($/*+

8$'.+'(#/$+B%""+#'+'(#/$+B%""O+%#+*,88/$/)#+

"/W/"&+B,""+W%$2V+,/+51.+%#+#D/+/>,0%&#$,(.V+64H1.+%#+#D/+@,8($1%#,')+

E(&,8'$.+%)/($2&.&+%$/+#D/+#2>/+.'&#+

1'..')"2+&//)+,)+#D/+%@*'.,)%"+%'$#%4+

3'&#+8(&,8'$.+%)/($2&.&+%$/+#$(/+

%)/($2&.&4+GD/+B/%A)/&&+,&+'8#/)+%"')0+%)+

/T#/)*/*+&/1#,')+'8+#D/+%'$#%+%)*+,)W'"W/&+

#D/+%'$#%p&+/)#,$/+1,$1(.8/$/)1/4+GD/+B/%A/)/*+>'$#,')+%>>/%$&+%&+%+$'(0D"2+&2../#$,1%"+

@("0/V+%&+&D'B)+,)+#D/+,.%0/4+

9%11("%$+%)/($2&.&+%>>/%$+",A/+%+&.%""+@",&#/$+'$+

@"/@+')+#D/+&,*/+'8+#D/+%'$#%+%)*+%$/+%&2../#$,1%"4+

GD/2+.%2+@/+>&/(*'%)/($2&.&+1%(&/*+@2+#$%(.%V+

&(1D+%&+%+1%$+%11,*/)#V+'$+@2+%+>/)/#$%#,)0+%'$#,1+

("1/$4++

`,&&/1#,)0+%)/($2&.&+'11($+BD/)+%+#/%$+@/0,)&+

B,#D,)+#D/+B%""+'8+#D/+%'$#%+1%(&,)0+#D/+B%""+"%2/$&+

#'+&/>%$%#/4+`,&&/1#,')&+1%)+1%(&/+%)/($2&.&V+@(#+

%)+/T,&#,)0+%)/($2&.+1%)+%"&'+*,&&/1#4+GD,&+,&+.'$/+

1'..')"2+&//)+,)+#D/+#D'$%1,1+%'$#%4+

G$%*,#,')%"+&1$//),)0+8'$+&(&>/1#/*+FFF+D%&+@//)+

>D2&,1%"+/T%.,)%#,')+>"(&+8($#D/$+,.%0,)0+8'$+D,0D+

$,&A+1%&/&4+F#+@/&#+#D,&+./#D'*+,&+')"2+PR+o+&/)&,#,W/+

8'$+FFF4++7'.>(#/*+#'.'0$%>D2+,&+#D/+0'"*+

&#%)*%$*+,)W/&#,0%#,')V+@(#+1%)+"/%*+#'+%+*/"%2+,)+

*/8,),#,W/+*,%0)'&,&+%)*+#$/%#./)#4++F)+/%$"2+("#$%&'()*+&1%)+,&+#D/+>$,.%$2+,)W/&#,0%#,')+'8+

1D',1/4+GD,&+,&+D/">8("+8'$+#D'&/+>%#,/)#&+BD'+%$/+$/=(,$,)0+$/&(&1,#%#,')V+%)*+%"&'+8'$+#D'&/+

>%#,/)#&+,)+BD'.+')/+B%)#&+#'+,*/)#,82+%)+%)/($2&.+/%$"2V+&'+%&+#'+/)&($/+%)+'>#,.%"+

1",),1%"+.%)%0/./)#+>"%)4+

36

Key point: As abdominal pain and collapse are common, a low threshold should exist for

scanning the abdominal aorta in Emergency Department patients.

+

F+&1%)+&D'("*+%"B%2&+@/+1%$$,/*+'(#+BD/)+%)+FFF+,&+

&(&>/1#/*4+E/%#($/&+'8+%+&(&>/1#/*+%@*'.,)%"+%'$#,1+

%)/($2&.+,)1"(*/_+

n!)/T>"%,)/*+@%1A+'$+%@*'.,)%"+>%,)+,)+%)+'"*/$+

>%#,/)#+

nS/)%"+1'",1+,)+%)+'"*/$+>%#,/)#+

n92)1'>%"+/>,&'*/+,)+%)+'"*/$+>%#,/)#+

n7",),1%"+/T%.,)%#,')+

nS,&A+8%1#'$&+?+I&1D%/.,1+D/%$#+*,&/%&/+NI\Òd+

C/$,>D/$%"+W%&1("%$+*,&/%&/+NCJÒd+%0/+

+

+

+

+

+

I.%0,)/+#D/+>$'@/+,&+%+#'$1DV+%)*+

,.%0,)/+&D,),)0+,#+#'B%$*&+#D/+,)#/$)%"+

%$/%+BD,1D+2'(+B%)#+#'+&//4++9#%$#+%#+

the epigastrium4+F,.+#'+0/#+%&+D,0D+%&+

2'(+1%)+8'$+#D/+8,$&#+W,/B4+I8+#D/+>%#,/)#+

D%&+/%#/)+$/1/)#"2+,#+.%2+)'#+@/+

>'&&,@"/+#'+W,/B+@/2')*+#D/+

&#'.%1Dd*('*/)(.4+++E,$&#"2V+@/0,)+B,#D+

#D/+>%#,/)#+,)+#D/+&(>,)/+>'&,#,')4++9#%$#+

B,#D+%+#$%)&W/$&/+&/1#,')4+I*/)#,82+#D/+

W/$#/@$%"+@'*2+N>$/?W/$#/@$%"+&#$,>/+%)*+

%1'(&#,1+&D%*'BO4+GD/+%'$#%+",/&+

%)#/$,'$+#'+#D/+/1D'?@$,0D#+>$/?W/$#/@$%"+

&#$,>/4+!&/+#D/+"/8#+"'@/+'8+#D/+",W/$+%&+#D/+

,),#,%"+%1'(&#,1+B,)*'B4+

+

+

+

q'(+&D'("*+,.%0/V+%&+&D'B)V+#D/+1'/",%1+%T,&V+

#D/)+#D/+&(>/$,'$+./&/)#/$,1+%$#/$2+N93FO4+M'B/$+

2'(+B,""+8,)*+#D/+$/)%"+W/&&/"&V+%)*+%$'()*+#D/+

(.@,",1(&+#D/+@,8($1%#,')+%)*+'$,0,)+'8+#D/+,",%1+

%$#/$,/&4+

Key point: Start in transverse section before

moving on to a longitudinal section.

+

+

37

GD/+1'/",%1+%T,&+,&+&//)+D,0D+,)+#D/+

/>,0%&#$,(.4+GD/+*,W,&,')+,)#'+&>"/),1+%$#/$2+

%)*+D/>%#,1+%$#/$2+,&+&%,*+#'+$/&/.@"/+#D/+

B,)0&+'8+%+&/%0(""V+B,#D+/%1D+*,W,&,')+

%>>/%$,)0+%&+%+B,)04++a8#/)+@'B/"+0%&+

'@&1($/&+#D/+1'/",%1+%T,&V+%)*+#D,&+W,/B+.%2+

@/+*,88,1("#+#'+'@#%,)4+++

+

M'B/$+*'B)+,&+#D/+&(>/$,'$+./&/)#/$,1+%$#/$2+

N93FOV+BD,1D+D%&+%+1D%$%1#/$,&#,1+

%>>/%$%)1/4+XD/)+&//)+,)+#$%)&W/$&/+

&/1#,')V+,#+,&+,.>'$#%)#+#D%#+#D/+j&)'B.%)e+@/+$/1'0),&/*4++

+

9/1')*"2V+'@#%,)+longitudinal images+'8+#D/+/)#,$/+

%@*'.,)%"+%'$#%4++c'#,1/+D'B+,)+#D/+,.%0/+#D/+%'$#%+

.'W/&+8$'.+=(,#/+*//>+%#+#D/+*,%>D$%0.V+#'+.(1D+

.'$/+&D%""'B+%#+#D/+(.@,",1(&4++GD,&+,&+*(/+#'+#D/+)'$.%"+

"(.@%$+"'$*'&,&4+

+

GD/+93F+,&+$/%*,"2+&//)V+#'0/#D/$+B,#D+

#D/+"(.@%$+W/$#/@$%"+@'*,/&+%)*+*,&1&+

,)+#D/+@%1A0$'()*4+

+

+

+

GD,$*"2V+.'W/+#D/+probe+&",0D#"2+'W/$+#'+#D/+$,0D#+#'+W,/B+#D/+

,)8/$,'$+W/)%+1%W%+NIJ7O+,)+"')0,#(*,)%"+&/1#,')4++J,/B,)0+#D/+

IJ7+%&+,#+>%&&/&+#D$'(0D+#D/+*,%>D$%0.+1%)+0,W/+%)+

,)*,1%#,')+'8+#D/+"'%*+')+#D/+$,0D#+&,*/+'8+#D/+D/%$#4+

+

I)+()W/)#,"%#/*+>%#,/)#&V+,8+#D/+IJ7+*,%./#/$+NIJ7Ò+,&+r:H+..+

B,#D+.,),.%"+1'""%>&/V+#D,&+,&+,)*,1%#,W/+'8+,)1$/%&/*+$,0D#+%#$,%"+

>$/&&($/+NSFCO+/404+1'$+>(".')%"/V+8"(,*+'W/$"'%*4+F+*,%./#/$+

'8+s6H+..+B,#D+1'.>"/#/+1'""%>&/+,&+,)*,1%#,W/+'8+@/,)0+

()*/$+8,""/*:K4+

38

+

I)+W/)#,"%#/*+>%#,/)#&V+#D/+1'$$/"%#,')+@/#B//)+#D/+IJ7`+%)*+SFC+,&+"/&&+$/",%@"/4++S/&/%$1D+

&(00/&#&+#D%#+%&&/&&./)#+%#+/)*?/T>,$%#,')+(&,)0+-7L+&2)1D$'),&%#,')+,.>$'W/&+1'$$/"%#,')4+

+E($#D/$.'$/V+*,%./#/$&+'W/$+6:+..+%>>/%$+#'+D%W/+)'+>$/*,1#,W/+W%"(/+'8+SFCV+BD/$/%&+

*,%./#/$&+@/"'B+6:..+.%24++F)+IJ7`+#D%#+,&+&//)+#'+W%$2+#D$'(0D'(#+#D/+$/&>,$%#'$2+121"/+

D%&+@//)+%&&'1,%#/*+B,#D+8"(,*+$/&>')&,W/)/&&V+BD/$/%&+.,),.%""2+W%$2,)0+IJ7`+D%&+@//)+

%&&'1,%#/*+B,#D+"/&&+8"(,*+$/&>')&,W/)/&&4+

Key point: IVC assessment can give an indication of hydration4++

+

E,)%""2V+./%&($/+#D/+%)#/$'?>'&#/$,'$+*,%./#/$+'8+#D/+%'$#%4++GD/+./%&($/./)#&+&D'("*+@/+

8$'.+'(#/$+B%""+#'+'(#/$+B%""+'8+#D/+W/&&/"4+F)2+1"'#+'$+8%"&/+"(./)+&D'("*+@/+,0)'$/*+BD/)+

./%&($,)04+

+

Y/+1%$/8("+#'+%W',*+#B'+>,#8%""&4+ a)/+,&+#%A,)0+%+)')?

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#D/$/@2+1$/%#,)0+%+j&%"%.,+&",1/e+

B,#D+'W/$?/&#,.%#,')+'8+#D/+

*,%./#/$4+F&+#D/+%'$#%+,&+%)0"/*+

%0%,)&#+#D/+"(.@%$+"'$*'&,&V+#D/+

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1%(*%""2+#'+'W/$1'./+#D,&4+GD/+

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#'$#('(&+%'$#%V+#D'(0D+#D,&+')"2+

1$/%#/&+&,0),8,1%)#+>$'@"/.&+,8+

#$%)&W/$&/+./%&($/./)#&+%$/+

#%A/)4++

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./%&($/./)#4++I)+#D/+1%&/+&D'B)+D/$/V+#D/+%)#/$'?>'&#/$,'$+./%&($/./)#+D%&+@//)+

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..4++

+

GD/$/+%$/+.%)2+>,#8%""&+,)+FFF+

&1%)),)0V+>$/*'.,)%)#"2+@2+)'#+

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%)/($2&.%"4+

+

39

`'+)'#+/T1"(*/+%)+FFF+()"/&&+#D/+BD'"/+%@*'.,)%"+%'$#%+%)*+>$'T,.%"+,",%1+%$#/$,/&+D%W/+

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%##/.>#,)0+#'+%)&B/$+%+"/0,#,.%#/+=(/&#,')4+

+

+

3.4 Ultrasound Guided Vascular Access

Context I)+$'(#,)/+-./$0/)12+3/*,1,)/+>$%1#,1/+B/+(&/+>/$,>D/$%"+W/)'(&V+1/)#$%"+W/)'(&+%)*+

%$#/$,%"+1%#D/#/$&+,)+%*("#&+%)*+1D,"*$/)4+!"#$%&'()*+D%&+@//)+(&/*+#'+%&&,&#+",)/+>"%1/./)#+

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c%#,')%"+I)&#,#(#/+8'$+7",),1%"+-T1/""/)1/+NcI7-O:Q+D%&+D,0D",0D#/*+#D/+)//*+8'$+#D/+(&/+'8+

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8/.'$%"+%)*+>/$,>D/$%"+1%))("%#,')4+

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Indications+

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+

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+

+

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40

GD/+ (&/+ '8+ %+ 1/)#$%"+ 1%))("%+ ,&+ ,../)&/"2+ D/">8("+ BD/)+

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Definition

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! C/$,>D/$%"+1%))("%#,')+$/8/$&+#'+@%&,",1+W/,)+1%))("%#,')++

+

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41

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1'W/$,)0+%)*+#D/+>$'1/*($/+,&+>/$8'$./*+B,#D+&,.("#%)/'(&+("#$%&'()*+W,&(%",&%#,')+'8+#D/+

1%))("%#,')4++GD,&+,&+$/1'../)*/*4+

+

+

Clinical assessment & risk stratification

F""+ 1%))("%#,')&V+ ("#$%&'()*+0(,*/*+'$+'#D/$B,&/V+%$/+'@W,'(&"2+ ()*/$#%A/)+ ,)+ #D/+ ",0D#+'8+

#D/+ 1",),1%"+ &/##,)04+ GD/+ ,)*,1%#,')&+ D%W/+ @//)+ 1'W/$/*+ ,)+ Z7')#/T#[i+ D'B/W/$V+ ,#+ ,&+

,.>'$#%)#+#'+$/>/%#+#D%#+,)#/$)%"+](0("%$+%)*+8/.'$%"+1%))("%#,')+%$/+,)W%&,W/+#/1D),=(/&V+

)'#+B,#D'(#+$,&A+'8+D%$.V+%)*+&D'("*+D%W/+%*/=(%#/+](&#,8,1%#,')4+

+

GD/&/+#/1D),=(/&+1%)+@/+(&/*+,)+1D,"*$/)5:V55V+%)*+("#$%&'()*+0(,*/*+8/.'$%"+1%))("%#,')+

1%)+ @/+ $%>,*+ %)*+ /T#$/./"2+ D/">8("+ ,)+ #D/+ W/$2+ &,1A+ 1D,"*4+ + GD/+ 0$',)+ ,&+ '8#/)+ $/%*,"2+

%W%,"%@"/+BD,"/+#D/+)/1A+,&+)'#+*(/+#'+%,$B%2+.%)'/(W$/&4+

+

7')&/)#+ &D'("*+ %"B%2&+ @/+ ()*/$#%A/)V+ BD,1D+ ,)+ #D/+ $/"%#,W/"2+ 1$,#,1%"+ 1')#/T#+ '8+ #D/+

-./$0/)12+ `/>%$#./)#V+ B,""+ (&(%""2+ @/+ W/$@%"4+ + I#+ ,&+ B,&/+ #'+ *'1(./)#+ ZJ/$@%"+ 1')&/)#+

'@#%,)/*[+,)+#D/+)'#/&+@/8'$/+&#%$#,)04+

+

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&%8/$4++X/+D%W/+%"$/%*2+&#%#/*+#D%#+,#&+(&/+*/1$/%&/&+1'.>",1%#,')&V+,)1$/%&/&+#D/+8,$&#?#,./+

&(11/&&+ '8+ ",)/+ >"%1/./)#V+ */1$/%&/&+ #D/+ )(.@/$+ '8+ /88'$#&+ $/=(,$/*+%)*+*/1$/%&/&+ #D/+

'W/$%""+ #,./+ &>/)#+ 1%$$2,)0+ '(#+ #D/+ #/1D),=(/4+ + I)+ %**,#,')V+ ,#+ $/&("#&+ ,)+ %+ &(11/&&8("+

1%))("%#,')+,)+'#D/$B,&/+*,88,1("#+1%&/&4+

46

+

I)+'#D/$+-3+("#$%&'()*+%>>",1%#,')&+,#+,&+%11/>#%@"/+#'+"/%$)+')+D(.%)&V+/,#D/$+W'"()#//$&+'$+

>%#,/)#&4+ \'B/W/$+ ,)+ W%&1("%$+ %11/&&V+ #D/+ ,)W%&,W/+ )%#($/+ $/=(,$/&+ %+ 1/$#%,)+ %.'()#+ '8+

#$%,),)0+')+&,.("%#'$&4++GD/+.'&#+@%&,1+'8+#D/&/+,&+%+#D,)+#(@/+,)+%+@"'1A+'8+&'8#+0/"V+%)*+#D/&/+

1%)+@/+.%*/+ $/%*,"24+ + GD,&+ #2>/+'8+ &,.("%#'$+ D/">&+ #D/+ #$%,)//+ #'+0%,)+ #D/+D%)*?/2/+1'?

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+

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&D'("*+@/+"/%$)/*+,)+#D,&+B%2+,8+>'&&,@"/4++GD/+#$%,)//+BD'+%"$/%*2+D%&+/T>/$,/)1/+,)+1/)#$%"+

W/)'(&+ 1%))("%#,')+ B,""+ @/+ %@"/+ #'+ .,0$%#/+ #'+ ("#$%&'()*?0(,*/*+ 1%))("%#,')+ B,#D'(#+ %+

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+

I)+%""+,)&#%)1/&+#D/$/+,&+#D/+)//*+8'$+&(88,1,/)#+')/+#'+')/+&(>/$W,&,')+@2+#D/+#$%,)/$4+

+

C$/1%(#,')&+

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B,#D+ ,)1$/%&/*+ #/1D),1%"+ *,88,1("#"24+ + G$/%#./)#+ '8+ D2>'W'"%/.,1+ &D'1A+ D%&+ %"B%2&+ @//)+

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(&,)0+("#$%&'()*V+7J7+,&+)'#+*,88,1("#+,)+#D/+D2>'W'"%/.,1+>%#,/)#+(&,)0+5;'+D/%*+*'B)5K4+

+

+

Technique

9/"/1#+ #D/+ 1'$$/1#+ >$'@/+ %)*+ .%1D,)/+ &/##,)0&+ %&+ >$/W,'(&"2+ */&1$,@/*4+ F""+ ,)W%&,W/+

>$'1/*($/&+&D'("*+/.>"'2+&#%)*%$*+&#/$,"/+#/1D),=(/&+#'+*,.,),&D+#D/+$,&A+'8+,)8/1#,')4++

E'$+W/)'(&+%11/&&+(&,)0+$/%"+#,./+("#$%&'()*V+%+&#/$,"/+>$'@/+1'W/$+&D'("*+%"B%2&+@/+(&/*4++

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1%))("%#,')4+

+

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#D/+&1$//)4+

+

q'(+B,""+ &'')+*,&1'W/$+ #D/+)//*+ #'+ &#%@,",&/+ #D/+>$'@/+

B,#D+ #D/+ ",##"/+ 8,)0/$+ #'(1D,)0+ #D/+ &A,)4+ + + !)"/&&+ 2'(+*'+

#D,&V+ #D/+ &",>>/$2+)%#($/+'8+ #D/+0/"+B,""+ ,)/W,#%@"2+./%)+

#D%#+ 2'($+ >$'@/+ &"'B"2+ *$,8#&+ %)*+ 2'(+ "'&/+ #D/+ &1$//)+

,.%0/4++I)+%""+,)W%&,W/+>$'1/*($/&+,#+,&+,.>'$#%)#+#'+"/%$)+

#'+B%#1D+ #D/+&1$//)V+)'#+2'($+D%)*&4+ + GD,&+ ,)W'"W/&+%)+

%>>$/1,%#,')+ '8+ BD,1D+ B%2+ #'+ .'W/+ #D/+ 1%))("%+ #'+

%1D,/W/+#D/+*/&,$/*+$/&("#4+

+

+

+

47

GD/+ 8,$&#+ &A,""+ #'+ %1=(,$/+ ,&+ #'+ @/+ %@"/+ #'+ $/1'0),g/+ #D/+ W/,)+ ,)+ #$%)&W/$&/+ &/1#,')V+ %)*+ #'+

*,&#,)0(,&D+,#+8$'.+#D/+%$#/$2+@2+W,$#(/+'8+,#&+1'.>$/&&,@,",#24++GD/)+"/%$)+#'+$'#%#/+#D/+>$'@/+#'+

W,/B+ #D/+ W/,)+ ,)+ "')0,#(*,)%"+ &/1#,')4+ + GD,&+ /)#%,"&+ A)'B,)0+ BD,1D+ >%$#+ '8+ #D/+ >$'@/+

1'$$/&>')*&+#'+#D/+.%$A/$+')+#D/+&1$//)4+++

+

J/)'(&+ 1%))("%#,')+ 1%)+ @/+ 1%$$,/*+ '(#+ (&,)0+ %+ &,)0"/+ '$+ *(%"+ '>/$%#'$+ #/1D),=(/4+ + I#+ ,&+

$/1'../)*/*+#D%#+,),#,%""2+#D/+#$%,)//+B'$A&+B,#D+#D/+#$%,)/$+,)+%+*(%"+'>/$%#'$+#/1D),=(/V+

B,#D+#D/+("#$%&'()*+1%$$,/*+'(#+@2+#D/+#$%,)/$V+%)*+#D/+1%))("%#,')+@2+#D/+#$%,)//4++Y/&,*/&+

#D/+'@W,'(&+#$%,),)0+@/)/8,#V+#D,&+%"&'+8$//&+(>+@'#D+D%)*&+8'$+#D/+#$%,)//4++I#+%"&'+&,0),8,1%)#"2+

$/*(1/&+ #D/+ $,&A&+ '8+ #D/+ >$'@/+ &",*,)0+ '88+ #D/+ %$/%+ '8+ B'$A+ %)*+ ')#'+ #D/+ 8"''$4+ + GD/+

1')&/=(/)1/&+ '8+ *$'>>,)0+ %+ >$'@/+ %$/+.'$/+ #D%)+ ,)1')W/),/)1/+ %)*+ "'&&+ '8+ &#/$,",#2+ U+

1$2&#%"&+.%2+@/+@$'A/)+,)+#D/+>$'@/+$/&("#,)0+,)+>/$.%)/)#+*%.%0/4+

+

GD/+8,)%"+#,>+,&+#'+@/+%B%$/+#D%#+&'')+%8#/$+%+W/&&/"+,&+/)#/$/*V+,8+&(11/&&8("+1%))("%#,')+*'/&+

)'#+'11($V+%+&.%""+1"'#+.%2+8'$.+,)+#D/+"(./)+'8+#D/+1%))("%4++GD,&+1%)+$/&("#+,)+&(@&/=(/)#+

8%,"($/+ #'+ 0/#+ %)2+ 8"%&D?@%1AV+ /W/)+ BD/)+ #D/+ 1%))("%+ ,&+ 1'$$/1#"2+ >"%1/*4+ + C$,.,)0+ #D/+

1%))("%+B,#D+D/>%$,),&/*+&%",)/+1%)+.,),.,&/+#D,&V+@(#+B,""+)'#+>$/W/)#+,#4+

+

S/%"+#,./+0(,*/*+1%))("%#,')+,&+*/&1$,@/*+,)+#D/+8'""'B,)0+&",*/&+8'$+/%1D+'8+#D/+#D$//+%$/%&+

N,)#/$)%"+ ](0("%$V+ 8/.'$%"+ %)*+ @%&,",1O4+ + I)+ $/%"+

#,./+ 1%))("%#,')+ #D/$/+ %$/+ #B'+ %11/>#/*+

%>>$'%1D/&_+

+

! GD/+ &D'$#+ %T,&V+ #$%)&W/$&/+ %>>$'%1D+

%""'B&+')"2+%+1$'&&+&/1#,')+'8+#D/+)//*"/+#'+@/+

W,&(%",&/*+ @2+ #D/+ ("#$%&'()*+ @/%.+ %)*+ .%2+

"/%*+ #'+ /$$'$&+ ,)+ */>#D+ >/$1/>#,')+ '8+ #D/+

)//*"/4+ + + GD/+ %1'(&#,1+ &D%*'B+ 1%)+ "/%*+ #'+

1')8(&,')4+ + GD/+ >'#/)#,%"+ '8+ #D/+ &1%)+ ,&+ )'#+

'>#,.,&/*+@2+#D,&+%>>$'%1D4++

+

+

+

+

+

+

+

+

! GD/+ "')0+ %T,&+ '$,/)#%#,')+

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&A,)+%)*+ ,)#'+ #D/+W/&&/"4+ + GD/+ "')0+

%T,&+ '$,/)#%#,')+ ,&+ #D/+ >$/8/$$/*+

%>>$'%1D4++

+

48

+

9>/1,8,1+#/1D),=(/&++

A Jugular

C$/>%$%#,')+

9#/$,"/+&/##,)0V+*$%>/&V+0"'W/&+/#1+

9/"*,)0/$+1%))("%+'8+1D',1/+

9#/$,"/+&D/%#D+8'$+("#$%&'()*+>$'@/4++9#%)*%$*+0/"+B,#D,)+&D/%#D+%)*+&#/$,"/+0/"+'(#&,*/+U+1%)+

(&/+1%#D/#/$,g%#,')+",0)'1%,)/4++9/1($/+B,#D+%+&#/$,"/+@%)*+

9/#+("#$%&'()*+#'+6;3\g+",)/%$+>$'@/V+&D'("*+*/8%("#+#'+%>>$'T+K+1.+*/>#D+

!&/+"'1%"+%)%/&#D/#,14+

+

C'&,#,'),)0+

C%#,/)#+ 5;'+ D/%*?*'B)V6;+ ",##"/+ )/1A+ $'#%#,')+ %)*+

)'+ /T#/)&,')6:4+ + GD,&+.%T,.,&/&+ W/)'(&+ 8,"",)0V+ %)*+

$/*(1/&+#D/+$,&A+'8+%,$+/.@'",&.4+

+

+

+

C$'1/*($%"+#/1D),=(/+

I)+ 1$'&&+ &/1#,')V+ 8,)*+ W/,)+ NR;o+ 'W/$+ '$+

"%#/$%"+#'+%$#/$2+%)*+1'.>$/&&,@"/O+

S'#%#/+>$'@/+#'+&//+W/,)+,)+"')0,#(*,)%"+

&/1#,')4++7D/1A+,#+,&+&#,""+1'.>$/&&,@"/+

I)#$'*(1/+)//*"/+#D$'(0D+#D/+&A,)+@/W/"+

(>B%$*&++

X%#1D+,#+/)#/$+#D/+W/,)+

+

XD/)+@"''*+'@#%,)/*+8//*+,)+B,$/+

7D/1A+,#+,&+@/,)0+8/*+1%(*%""2++

a@&/$W/+>$'0$/&&+')+&1$//)+

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Y/B%$/+'8+%1'(&#,1+&D%*'B+%&+,#+1%)+@/+

W/$2+'88?>(##,)0h++E//*+#D/+1%))("%+'W/$+#D/+

B,$/+

9/1($/+#D/+",)/4+7D/1A+#D/+",)/+>'&,#,')+B,#D+

%+7bS+

49

B Femoral

C$/>%$%#,')+

F&+8'$+7J7+

+

C'&,#,'),)0+

C%#,/)#+H'+D/%*?(>4++GD,&+/)&($/&+8,"",)0+'8+#D/+W/,)+

B,#D'(#+()*(/+>$/&&($/4+

+

C$'1/*($%"+#/1D),=(/+

I)+ 1$'&&+ &/1#,')V+ 8,)*+ W/,)+

N./*,%"+'$+./*d%)#+#'+%$#/$2O+

S'#%#/+ >$'@/+ #'+ &//+ W/,)+ ,)+

"')0,#(*,)%"+&/1#,')4+ +7D/1A+ ,#+

,&+&#,""+1'.>$/&&,@"/+

I)#$'*(1/+)//*"/+#D$'(0D+#D/+

&A,)+@/W/"+(>B%$*&++

X%#1D+,#+/)#/$+#D/+W/,)+

XD/)+@"''*+'@#%,)/*+8//*+,)+

B,$/+ aSV+ ,8+ 1%))("%+ 'W/$+

)//*"/V+ #D$/%*+ 1%))("%+ ,)#'+

#D/+W/,)+

a@&/$W/+ #D/+ >$'0$/&&+ ')+

&1$//)+

7D/1A+,#+$/.%,)&+,)+#D/+"(./)+

Y/B%$/+ '8+ #D/+ %1'(&#,1+

&D%*'B+ U+ ,#+ 1%)+ @/+ W/$2+ '88?

>(##,)0h+

9/1($/+#D/+",)/+

+

+

+

50

C Peripheral37

C$/>%$%#,')+

F&+@/8'$/+

+

C'&,#,'),)0+

GD/+ #/1D),=(/+ ,&+.'&#+ 8%1,",#%#/*+@2+ #D/+ (>>/$+ ",.@+@/,)0+ D/">+ /T#/)*/*+%)*+/T#/$)%""2+

$'#%#/*V+ '$+ @2+ #D/+ D%)*&+ @/,)0+

@/)/%#D+#D/+>%#,/)#&+D/%*4+

+

C$'1/*($%"+#/1D),=(/+

I)+1$'&&+&/1#,')V+8,)*+#D/+@%&,",1+W/,)+

N,)+#D/+$/1/&&+./*,%"+#'+#D/+@,1/>&+

.(&1"/O+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

S'#%#/+#D/+>$'@/+#'+&//+#D/+W/,)+,)+

"')0,#(*,)%"+&/1#,')4++7D/1A+,#+,&+&#,""+

1'.>$/&&,@"/+

+

I)#$'*(1/+ )//*"/+ #D$'(0D+ #D/+ &A,)+

@/W/"+(>B%$*&++

X%#1D+,#+/)#/$+#D/+W/,)+

XD/)+@"''*+'@#%,)/*+8//*+ ,)+B,$/+

aSV+,8+1%))("%+'W/$+)//*"/V+#D$/%*+

1%))("%+,)#'+W/,)+

a@&/$W/+>$'0$/&&+')+&1$//)+

7D/1A+,#+$/.%,)&+,)+#D/+"(./)+

Y/B%$/+'8+#D/+%1'(&#,1+&D%*'B+

I8+9/"*,)0/$V+8//*+#D/+1%))("%+'W/$+

#D/+B,$/4++9/1($/+#D/+",)/+

+

51

Further management (general and specific)

F"B%2&+.%,)#%,)+&#/$,",#2+

F"B%2&+.%,)#%,)+",)/+&/1($,#24++F>%$#+8$'.+D%W,)0+2'($+>$/1,'(&+",)/&+>(""/*+'(#+@2+%11,*/)#V+

&,0),8,1%)#+@"//*,)0+'$+%,$+/.@'",&.+.%2+'11($+#D$'(0D+1%$/"/&&+",)/+1%$/4+

I)+ >%#,/)#&+ BD'+ %$/+ D2>'W'"%/.,1V+ ')1/+ &'./+ 8"(,*+ ,&+ ,)#$'*(1/*V+ #D/+ W/)'(&+ &2&#/.+

@/1'./&+.'$/+%11/&&,@"/+#'+1')W/)#,')%"+1%))("%#,')4+

Pitfalls - all

F,$+/.@'",&.+

M'&&+'8+&#/$,",#2+

Y$/%A%0/+'8+>$'@/+

`$'>>,)0+#D/+>$'@/+N&'+(&/+%+&/1')*+'>/$%#'$dD/">/$+BD,"/+2'(+0%,)+/T>/$,/)1/6KO+

M+?+S+*,&'$,/)#%#,')+')+&1$//)+

CVC

c'#+8,"",)0+#D/+W/,)+@2+(&,)0+D/%*+*'B)+

J/,)+1'.>$/&&,')+@2+>$'@/+'$+#''+.(1D+)/1A+$'#%#,')+

Femoral

\%/.'$$D%0/+

Peripheral

`%.%0/+#'+#D/+@$%1D,%"+%$#/$2+BD,1D+,&+1'.>$/&&,@"/+,8+&(88,1,/)#+>$/&&($/+,&+%>>",/*4+

+

+

3.5 Echocardiography in Life Support (ELS)

N&//+%"&'+()*/$+EF9GV+&/1#,')+54:O+

+

GD,&+ ,&+ %+ ",.,#/*+ /1D'1%$*,'0$%.+ (&/*+ ,)+ #D/+ &/##,)0+ '8+ )')?&D'1A%@"/+ 1%$*,%1+ %$$/&#+

$D2#D.&+NC-F+%)*+%&2&#'"/O4++GD/+D/%$#+ ,&+/T%.,)/*+*($,)0+%+$D2#D.+1D/1A+8'$+B%""+.'#,')+

%)*+ #D/+ #$/%#%@"/+ 1%(&/&+ '8+ C-F+ N1%$*,%1+ #%.>')%*/V+ D2>'W'"%/.,%V+ %)*+ >(".')%$2+

/.@'",&.O4+ + F&&/&&+ #D/+ >/$,1%$*,%"+ &>%1/+ 8'$+ 8"(,*V+ "''A+ 8'$+ #D/+ >$/&/)1/d%@&/)1/+ %)*+

1D%$%1#/$+ '8+ W/)#$,1("%$+ B%""+ .'#,')V+ %)*+ "''A+ 8'$+ 0$'&&+ %@)'$.%",#,/&+ '8+ $,0D#+ %)*+ "/8#+

W/)#$,1("%$+ &,g/4+ GD/+ &(@T,>D',*+W,/B+ ,&+>$,.%$,"2+(&/*V+%(0./)#/*+@2+%+ 8($#D/$+W,/Bi+.'&#+

1'..')"2+#D/+>%$%&#/$)%"+"')0+%T,&+W,/B+N'#D/$+%>>$'>$,%#/+W,/B&+,)1"(*/+#D/+>%$%&#/$)%"+

&D'$#+%T,&+W,/B+%)*+#D/+%>,1%"+8'($+1D%.@/$+W,/BO4+I)+%**,#,')V+#D/+"')0#,*(*,)%"+&(@T,>D',*+

W,/B+ %""'B&+ W,&(%",&%#,')+ '8+ #D/+ ,)8/$,'$+ W/)%+ 1%W%+ NIJ7O+ 8'$+ %&&/&&./)#+ '8+ *,%./#/$+ %)*+

1'""%>&,@,",#24++

F1=(,&,#,')+'8+#D/+@/&#+>'&&,@"/+,.%0/_++

`/.')&#$%#/&+&(@T,>D',*+W,/B+%)*+#D/+"')0+%T,&+>%$%&#/$)%"+W,/B+

I*/)#,8,/&+>/$,1%$*,%"+&>%1/+%)*+%)2+8"(,*+#D%#+,&+>$/&/)#++

I*/)#,8,/&+>$/&/)1/d%@&/)1/+'8+W/)#$,1("%$+B%""+.'#,')++

7'../)#&+%>>$'>$,%#/"2+')+$,0D#+%)*+"/8#+W/)#$,1("%$+&,g/++

I*/)#,8,/&+IJ7+,)+M94+3/%&($/&+IJ7+*,%./#/$+%)*+1'""%>&,@,",#2+

52

4. Competences required for EMUS +

7'.>/#/)1/&+%$/+#D$//8'"*+%)*+$/=(,$/+#D/'$/#,1%"+%)*+>$%1#,1%"+#$%,),)0+#'+%1D,/W/4+

64 GD/'$2+U+1'W/$/*+,)+#D,&+1D%>#/$4+

:4 ^)'B,)0+D'B+#'+,)#/$>$/#+%+&1%)+U+>%$#"2+1'W/$/*+@(#+D%)*&?')+$/=(,$/*+

54 C$%1#,1%"+%@,",#2?+1%)+')"2+@/+%1D,/W/*+@2+D%)*&?')+

+

+

BASED UPON

OVERALL

ASSESSMENT

KNOWING

DOING

THINKING

(a) Competent to

scan and interpret

findings

+

+F@"/+#'+$/&/%$1D+

%)*+1$,#,=(/+#D%#+

A)'B"/*0/+%)*+(&/+

,#+B,&/"2+

+

M/%$)/$+*',)0_+

#/%1D/$+%W%,"%@"/+

@2+>D')/+

+

-T1/""/)#+

>$'8/&&,')%"+

](*0./)#&+

(b) Needs

supervision and if

scanning alone

cannot rely on

findings

+

F@"/+#'+()*/$&#%)*+

%)*+(&/+#D%#+

A)'B"/*0/+

+

M/%$)/$+*',)0_+

#/%1D/$+B,#D,)+-3+

/)W,$')&+

+

7",),1%"+$/%&'),)0+

%)*+*/",@/$%#,')+

(c) Not competent

at this stage

+

\%W,)0+#'+%&A+'$+@/+

#'"*+

+

G/%1D/$+&D'B,)0_+

M/%$)/$+%&&,&#,)0++

+

+

7",),1%"+$/%&'),)0+

+

+

53

5. Training +

GD/+#$%,),)0+>$'0$%.+,&+ #D/+&%./+8'$+@'#D+/&#%@",&D/*+>$%1#,#,')/$&+%)*+$/&,*/)#&4+GD,&+1%)+

@/+/,#D/$+*')/+Z,)+D'(&/[+'$+')+/T#/$)%"+%>>$'W/*+1'($&/&4++F&+%)+/T%.>"/V+#D/+7'""/0/+'8+

-./$0/)12+3/*,1,)/+D%&+%+)%#,')%"+)/#B'$A+'8+&(,#%@"/+1'($&/&+>(@",&D/*+')+#D/,$+B/@&,#/4

+

M/W/"+ 6+ #$%,),)0+ ,&+ &//)+ %&+ #D/+ &#%)*%$*+ '8+ A)'B"/*0/+ %)*+ >$%1#,1/+ #D%#+ 7$,#,1%"+ 7%$/+

*'1#'$&+&D'("*+D%W/+,)+#D/+8(#($/4+C$%1#,1/+%#+#D,&+ "/W/"+B'("*+(&(%""2+$/=(,$/+#D/+8'""'B,)0+

%@,",#,/&_+

+

! G'+>/$8'$.+1'..')+/T%.,)%#,')&+&%8/"2+%)*+%11($%#/"2+

! G'+$/1'0),&/+%)*+*,88/$/)#,%#/+)'$.%"+%)%#'.2+%)*+>%#D'"'02+

! G'+*,%0)'&/+1'..')+%@)'$.%",#,/&+B,#D,)+1/$#%,)+'$0%)+&2&#/.&+

! G'+$/1'0),&/+BD/)+%+$/8/$$%"+8'$+%+&/1')*+'>,),')+,&+,)*,1%#/*+

! G'+ ()*/$&#%)*+ #D/+ $/"%#,')&D,>+ @/#B//)+ ("#$%&'()*+ ,.%0,)0+ %)*+ '#D/$+ *,%0)'&#,1+

,.%0,)0+#/1D),=(/&+

+

GD/'$/#,1%"+#$%,),)0+

C$/",.,)%$2+ #D/'$/#,1%"+ #$%,),)0+ &D'("*+1'W/$+ $/"/W%)#+%)%#'.2V+ #D/+>D2&,1&+'8+ ("#$%&'()*V+

"/W/"&+ %)*+ &'>D,&#,1%#,')+ '8+ /=(,>./)#V+ ,.%0/+ $/1'$*,)0V+ $/>'$#,)0V+ %$#/8%1#&+ %)*+ #D/+

$/"/W%)1/+'8+'#D/$+,.%0,)0+.'*%",#,/&+#'+("#$%&'()*4++GD,&+/"/./)#+'8+#$%,),)0+.%2+@/+@/&#+

*/",W/$/*+@2+(&/+'8+#D/+7-3+/?"/%$),)0+.'*("/&4+

+

C$%1#,1%"+#$%,),)0+

C$%1#,1%"+/T>/$,/)1/+&D'("*+@/+0%,)/*+()*/$+#D/+0(,*%)1/+'8+%+)%./*+&(>/$W,&'$+#$%,)/*+

,)+("#$%&'()*+B,#D,)+%+ #$%,),)0+*/>%$#./)#4+ + + GD/+ &2""%@(&+ &/#+'(#+ ,)1"(*/&+%+1'.>/#/)12+

%&&/&&./)#+&D//#+8'$+#$%,),)04++GD,&+&D'("*+@/+1'.>"/#/*+*($,)0+#D/+1'($&/+'8+#$%,),)0V+%&+,#+

B,""+D/">+#'+*/#/$.,)/+,)+BD,1D+%$/%N&O+#D/+#$%,)//+1%)+>$%1#,&/+,)*/>/)*/)#"24++

+

" C$%1#,1%"+ #$%,),)0+ &D'("*+ ,)1"(*/+ $/0("%$+ /T%.,)%#,')&V+ ,*/%""2+ &(>/$W,&/*+ ,),#,%""24+ I8+ %+

#$%,)//+ ,&+()%@"/+ #'+%11/&&+ "'1%"+ &1%)),)0+'>>'$#(),#,/&V+ #D/+7-3+ $/0,')%"+("#$%&'()*+

1'?'$*,)%#'$+ .%2+ @/+ %@"/+ #'+ 8%1,",#%#/+ %$$%)0/./)#&+ 8'$+ 8($#D/$+ >$%1#,1/+ B,#D,)+#D/+

$/0,')4+

+

" GD/+ 0'%"+ '8+ #$%,),)0+ ,&+ 1'.>/#/)12V+ %)*+ #D,&+.(&#+ @/+ */.')&#$%#/*+ $%#D/$+ #D%)+ $,0,*+

%*D/$/)1/+#'+%+8,T/*+)(.@/$+'8+#$%,),)0+&1%)&4+++

+

" -T%.,)%#,')&+ &D'("*+ 1')1/)#$%#/+ ')+ #D/+ 1'$/+ 1",),1%"+ ,)*,1%#,')&+ '8+ #$%(.%V+ %'$#,1+

%)/($2&.+%)*+ IJ7+%&&/&&./)#+%)*+>/$,?%$$/&#+%&&/&&./)#+BD/$/+ #D/$/+%$/+@/)/8,#&+'8+

%)+/%$"2+8'1(&/*+("#$%&'()*+&1%)4+

+

" F+"'0@''A+",&#,)0+#D/+#2>/&+'8+/T%.,)%#,')+()*/$#%A/)+&D'("*+@/+A/>#4++F""+#$%,),)0+&1%)&+

.(&#+@/+"'00/*V+%)*+%+>,1#'$,%"+$/1'$*+1')#%,),)0+%)+,""(&#$%#/*+*/&1$,>#,')+'8+6;+1%&/&+

,)+BD,1D+ #D/+ #$%,)//+D%&+@//)+>/$&')%""2+ ,)W'"W/*+&D'("*+@/+1'""/1#/*+%)*+ ,&+%+(&/8("+

1')8,$.%#,')+'8+/T>/$,/)1/+BD/)+.'W,)0+@/#B//)+*/>%$#./)#&4+

+

54

" -3!9+(&/$&+BD'+D%W/+%1D,/W/*+"/W/"+6+1'.>/#/)12+N'$+,)W'A/+#D/+0$%)*8%#D/$+1"%(&/O+

&D'("*+$/0,&#/$+#D/,$+&#%#(&+B,#D+#D/+7-3+W,%+#D/+$/0,')%"+1'?'$*,)%#'$4+

+

" GD/+"/%$),)0+%)*+>$%1#,1/+'(#",)/*+,)+#D,&+*'1(./)#+$/8/$&+#'+%*("#&+%)*+1D,"*$/)4+

+

6. Trainers ++

G$%,),)0+&D'("*+@/+&(>/$W,&/*+@2+%+M/W/"+:+>$%1#,#,')/$+'$+%+M/W/"+6+>$%1#,#,')/$+B,#D+%#+"/%&#+

P+.')#D&+/T>/$,/)1/+'8+M/W/"+6+>$%1#,1/4+

+ +

ZL$%)*8%#D/$+1"%(&/[+

C$%1#,#,')/$&+BD'+D%W/+(&/*+!"#$%&'()*+,)+M/W/"+6+>$%1#,1/+8'$+&'./+#,./V+@(#+D%W/+)/W/$+

@//)+#D$'(0D+%)+%&&/&&./)#+>$'1/&&+.%2+@/+*//./*+#'+@/+ZM/W/"+6+1'.>/#/)#[+8'$+#D/+

>($>'&/&+'8+%>>$%,&%"+ ,8+ #D/2+D%W/+%+ "/##/$+ 8$'.+%+7')&("#%)#+ S%*,'"'0,&#+'$+%+7')&("#%)#+

>$%1#,1,)0+ ,)+ EF9Gd-EF9GdF7-9+ B,#D+ /T#/)&,W/+ ("#$%&'()*+ /T>/$,/)1/+ 1')8,$.,)0+ #D/,$+

1'.>/#/)1/4+ + GD,&+ "/##/$+ &D'("*+ @/+ D/"*+ B,#D,)+ #D/,$+ %>>$%,&%"+ 8'"*/$4+ + GD,&+ Z0$%)*8%#D/$+

1"%(&/[+,&+W/$2+",A/"2+#'+@/+B,#D*$%B)+,)+#D/+8(#($/+BD/)+$'@(&#+#$%,),)0+1%>%1,#2+/T,&#&4+

+

+

7. Assessment tool +

GD,&+,&+%+X'$A?@%&/*+àC9+A)'B)+%&+%+G$,00/$/*+F&&/&&./)#+U+&//+F>>/)*,T+:+

+

+

8. Maintenance of Skills +

\%W,)0+ @//)+ %&&/&&/*+ %&+ 1'.>/#/)#+ #'+ >$%1#,1/+ #D/$/+ B,""+ @/+ %+ )//*+ 8'$+ 7C`+ %)*+

.%,)#/)%)1/+'8+>$%1#,1%"+&A,""&4++F+#$%,)//+B,""+)//*+#'+1')#,)(/+#'+>/$8'$.+("#$%&'()*+&1%)&+

#D$'(0D'(#+ #D/+ $/.%,)*/$+ '8+ #D/+ #$%,),)0+ >$'0$%../+ %)*+ ,)#'+ D,&dD/$+ 1')&("#%)#+

%>>',)#./)#4+ + 9(1D+ 8($#D/$+("#$%&'()*+>$%1#,1/+.%2+@/+ ,)#/$.,##/)#V+@(#+)'+.'$/+ #D%)+5+

.')#D&+ &D'("*+/"%>&/+B,#D'(#+ #D/+ #$%,)//+(&,)0+D,&+ &1%)),)0+ &A,""&4+ + I8+.'$/+ #D%)+5+.')#D&+

/"%>&/&+#D/$/+.(&#+@/+%+@$,/8+$/?%&&/&&./)#+(&,)0+%+àC9+@2+%+#$%,)/$V+%)*+%+>'$#8'",'+)'#/+

.%*/4+

+

F""+>$%1#,#,')/$&+&D'("*+D%W/+$/0("%$+.//#,)0&+B,#D,)+#D/+*/>%$#./)#+#'+/)&($/+%>>$'>$,%#/+

8'1(&/*+/./$0/)12+("#$%&'()*+(&/4++GD/+*/>%$#./)#+"/%*+8'$+("#$%&'()*+>$%1#,1/+B,""+D%W/+

$/0("%$+1')#%1#+B,#D+ $%*,'"'0,1%"+1'""/%0(/&+%)*+&D'("*+D%W/+%+)%./*+$%*,'"'0,&#+%&+%)+

j("#$%&'()*+./)#'$e4+

+

C$%1#,#,')/$&+&D'("*_+

! I)1"(*/+("#$%&'()*+,)+#D/,$+')0',)0+73-d7C`+

! F(*,#+#D/,$+>$%1#,1/+

55

! C%$#,1,>%#/+,)+.("#,*,&1,>",)%$2+.//#,)0&+

! ^//>+(>+#'+*%#/+B,#D+$/"/W%)#+",#/$%#($/+

+

GD/+.,),.(.+ %.'()#+ '8+ ')?0',)0+ /T>/$,/)1/+ ,)+ ("#$%&'()*+ %&+ '(#",)/*+ ,)+ /%1D+ &2""%@(&+

&D'("*+@/+.%,)#%,)/*4+ +73-d7C`+ &D'("*+@/+()*/$#%A/)+BD,1D+ ,)1'$>'$%#/&+/"/./)#&+'8+

("#$%&'()*+>$%1#,1/4+

+

S/0("%$+%(*,#+'8+#D/+,)*,W,*(%"e&+("#$%&'()*+>$%1#,1/+&D'("*+@/+()*/$#%A/)+#'+*/.')&#$%#/+

#D%#+#D/+,)*,1%#,')&V+>/$8'$.%)1/+%)*+*,%0)'&#,1+=(%",#2+'8+#D/+&/$W,1/+%$/+%""+&%#,&8%1#'$24++

-.>"'2,)0+G$(&#&+&D'("*+/)&($/+#D%#+%)+%*/=(%#/+0'W/$)%)1/+8$%./B'$A+/T,&#&4+

+

+

9. Further Reading S/8/$+#'+#D/+8'""'B,)0+#/T#&+8'$+%**,#,')%"+,)8'$.%#,')_++

n+ Y'B$%+f+t+31M%(0D",)+S+ZEmergency Ultrasound Made Easy[+7D($1D,""++M,W,)0&#')/V+

:;;P++

n+ L%&>%$,+SfV+E'T+f7+t+9,/$g/)&A,+CS+ZEmergency Ultrasound – Principles and Practice[++++

++++++++++++3'&@2V+:;;P+

+

+

10. References 64+ 9"'%)+fC4+-./$0/)12+CD2&,1,%)+*,$/1#/*+!"#$%&'()*4++Ultrasound+3%2+:;;K4++

:4+ 3%+afV+3%#//$+fSV+a0%#%+3V+^/8/$+3CV+X,##.%))+`V+F>$%D%.,%)+74+C$'&>/1#,W/++

%)%"2&,&+'8+%+$%>,*+#$%(.%+("#$%&'()*+/T%.,)%#,')+>/$8'$./*+@2+/./$0/)12+

>D2&,1,%)&4+Journal of Trauma: Injury, Infection and Critical Care+6<<Hi+5RNPO_+RQ<?RRH4++

54+ f/D"/+`V+L(%$,)'+fV+^%$%.%)'(A,%)+\4+-./$0/)12+*/>%$#./)#+("#$%&'()*+,)+#D/+

/W%"(%#,')+'8+@"()#+%@*'.,)%"+#$%(.%4+American Journal of Emergency Medicine+

6<<5i+66NKO_+5K:?5KP4++

K4+ 31-"W//)+G9V+7'"",)+LS4+GD/+$'"/+'8+("#$%&')'0$%>D2+,)+@"()#+%@*'.,)%"+#$%(.%_+F+

>$'&>/1#,W/+&#(*24+The American Surgeon+6<<Qi+P5_+6RK?6RR4++

H4+ 31^/))/2+3LV+3%$#,)+MV+M/)#g+^V+M'>/g+7V+9"//.%)+`V+F$,&#,*/+LV+^,$#')+aV+c()/g+`V+

c%]]%$+SV+c%.,%&+cV+9'&%+f4+6V;;;+1')&/1(#,W/+("#$%&'()*&+8'$+@"()#+%@*'.,)%"+

#$%(.%4+Journal of Trauma: Injury, Infection and Critical Care 6<<Pi+K;NKO_+P;Q?P6:4++

P4+ 7D%.@/$&+fFV+C,"@$'B+Xf4+!"#$%&'()*+,)+F@*'.,)%"+G$%(.%_+%)+%"#/$)%#,W/+#'+

>/$,#')/%"+"%W%0/4+Archives of Emergency Medicine+6<RRi+H_+:P?554++

56

Q4+ Y$''A&+FV+`%W,/&+YV+9./#DD($&#+3V+7'))'""2+f4+C$'&>/1#,W/+/W%"(%#,')+'8+)')?

$%*,'"'0,&#+>/$8'$./*+/./$0/)12+%@*'.,)%"+("#$%&'()*+8'$+D%/.'>/$,#')/(.4+

Emergency Medicine Journal+:;;Ki+:6_+HR;?HR64++

R4+ Y$/)1D"/2+fV+X%"A/$+FV+9"'%)+fCV+\%&&%)+GYV+%)*+J/)%@"/&+\4+Z-W%"(%#,')+'8+8'1(&/*+

%&&/&&./)#+B,#D+&')'0$%>D2+,)+#$%(.%+NEF9GO+@2+!^+/./$0/)12+>D2&,1,%)&[4+

Emergency Medicine Journal+:;;P+f()i+:5_+KKPUKKR++

<4+ q'&D,,+\V+9%#'+3V+q%.%.'#'+9V+3'#/0,+3V+aA(&%B%+9V+^,#%)'+3V+c%0%&D,.%+FV+`',+3V+

G%A(.%+^V+^%#'+^V+F,AB%+c4++!&/8(")/&&+%)*+",.,#%#,')+'8+("#$%&')'0$%>D2+,)+#D/+,),#,%"+

/W%"(%#,')+'8+@"()#+%@*'.,)%"+#$%(.%4+Journal of Trauma: Injury, Infection and

Critical Care+6<<Ri+KHN6O_+KH?H64++

6;4+ I)0/.%)+f-V+C"/B%+37V+aA%&,)&A,+S-V+^,)0+SXV+^)'##&+EY4+-./$0/)12+>D2&,1,%)+(&/+'8+

("#$%&')'0$%>D2+,)+@"()#+%@*'.,)%"+#$%(.%4+Academic Emergency Medicine+6<<Pi+

5N6;O_+<56?<5Q4++

664+ L"%&/$+^V+G&1D./",#&1D+fV+^",)0"/$+CV+X/#&1D/$+LV+Y'*)/$+-4+!"#$%&')'0$%>D2+,)+#D/+

.%)%0/./)#+'8+@"()#+%@*'.,)%"+%)*+#D'$%1,1+#$%(.%4+Archives of Surgury+6<<Ki+

6:<_+QK5?QKQ4++

6:4+ G&'+CV+S'*$,0(/g+FV+7''>/$+7V+3,",#/""'+CV+3,$W,&+9V+Y%*/"",)'+33V+Y'("%)0/$+YSV+E'&&+

EFV+\,)&')+`3V+3,0D#2+\-V+c%&$%""%D+`JV+S%,.')*/+fV+q%#/&+X`V+q(&1D%A+fJ4++

9')'0$%>D2+,)+@"()#+%@*'.,)%"+#$%(.%_+%+>$/",.,)%$2+>$'0$/&&+$/>'$#4+Journal of

Trauma: Injury, Infection and Critical Care+6<<:i+55_+5<UKK4++

654+ 9D%1A8'$*+9SV+S'0/$&+EYV+a&"/$+G3V+G$%@("&2+3-V+7"%(&&+`XV+J%)/+`X4++E'1(&/*+

%@*'.,)%"+&')'0$%.+8'$+#$%(.%_+#D/+"/%$),)0+1($W/+'8+)')$%*,'"'0,&#+1",),1,%)&+,)+

*/#/1#,)0+D/.'>/$,#')/(.4+Journal of Trauma: Injury, Infection and Critical Care+

6<<<i+KPNKO_+HH5?HP:4++

6K4+ Y$%))/2+9XV+X'"8/+S-V+3''$/+--+/#+%"4+k(%)#,#%#,W/+&/)&,#,W,#2+'8+("#$%&'()*+,)+

*/#/1#,)0+8$//+,)#$%>/$,#')/%"+8"(,*4+Journal of Trauma+6<<H+F(0i+5<N:O_+5QH?R;4++

6H4+ E,)A+\FV+M/*/$"/+EFV+S'#D+79V+/#+%"4+GD/+%11($%12+'8+>D2&,1%"+/T%.,)%#,')+#'+*/#/1#+

%@*'.,)%"+%'$#,1+%)/($2&.4+Archives of Internal Medicine+:;;;i+160_+R55UP4++

6P4+ ^(D)+3V+Y')),)+SMV+`%W/2+3fV+/#+%"4+-./$0/)12+*/>%$#./)#+("#$%&'()*+&1%)),)0+8'$+

%@*'.,)%"+%'$#,1+%)/($2&._+%11/&&,@"/V+%11($%#/V+%)*+%*W%)#%0/'(&4+Annals of

Emergency Medicine+:;;;i+36_+:6<U:54++

57

6Q4+ G%2%"+J9V+L$%8+7`V+L,@@&+3F4+C$'&>/1#,W/+&#(*2+'8+%11($%12+%)*+'(#1'./+'8+

/./$0/)12+("#$%&'()*+8'$+%@*'.,)%"+%'$#,1+%)/($2&.+'W/$+#B'+2/%$&4+Academic

Emergency Medicine+:;;5i+10_+RPQUQ64++

6R4+ 7'&#%)#,)'+GLV+Y$()'+-7V+\%)*"2+cV+/#+%"4+F11($%12+'8+/./$0/)12+./*,1,)/+

("#$%&'()*+,)+#D/+/W%"(%#,')+'8+%@*'.,)%"+%'$#,1+%)/($2&.4+Journal of Emergency

Medicine+:;;Hi+29_+KHHUP;4++

6<4+ ^)%(#+FMV+^/)*%""+fMV+C%##/)+SV+/#+%"4+!"#$%&'()*+./%&($/./)#&+'8+%'$#,1+*,%./#/$+@2+

/./$0/)12+>D2&,1,%)&+%>>$'T,.%#/&+$/&("#&+'@#%,)/*+@2+1'.>(#/*+#'.'0$%>D24+

Journal of Emergency Medicine+:;;Hi+28_+66<U:P4++

:;4+ `/)#+YV+^/)*%""+SfV+Y'2"/+FFV+F#A,)&')+CSG4+-./$0/)12+("#$%&'()*+'8+#D/+%@*'.,)%"+

%'$#%+@2+!^+/./$0/)12+>D2&,1,%)&_+%+>$'&>/1#,W/+1'D'$#+&#(*24+Emergency

Medicine Journal+:;;Q+F(0i+24(8)_+HKQ?<4++

:64+ X%"A/$+FV+Y$/)1D"/2+fV+9"'%)+fCV+/#+%"4+!"#$%&'()*+@2+/./$0/)12+>D2&,1,%)&+#'+*/#/1#+

%@*'.,)%"+%'$#,1+%)/($2&.&_+%+!^+1%&/+&/$,/&4+Emergency Medicine Journal+:;;Ki+

21_+:HQU<4+

::4+ 9,/$g/)&A,+CSV+M//1D+9fV+`,1A.%)+-V+M/,@$%)*#+CcV+L(AD''"+fFV+Y'"",)0/$+3-4+

-./$0/)12+CD2&,1,%)+!"#$%&'()*+`/1$/%&/&+G,./+#'+`,%0)'&,&V+G,./+#'+7G+91%)V+%)*+

G,./+#'+a>/$%#,W/+S/>%,$+,)+C%#,/)#&+B,#D+S(>#($/*+F@*'.,)%"+F'$#,1+F)/($2&.4+

Academic Emergency Medicine+:;;Ki+11_+HR;++

:54+ Y/)0#&&')+\V+Y/$=W,&#+`+t+9#/$)@2+c\4+I)1$/%&,)0+>$/W%"/)1/+'8+%@*'.,)%"+%'$#,1+

%)/($2&.&V+%+)/1$'&1'>2+&#(*24++European Journal of Surgery+6<<:i+158_+6<?:54+

:K4+ 9/8,*@%AD#+9V+F&&%*&%)0%@,+SV+F@@%&,+\SV+c%@%W,g%*/D+F4+9')'0$%>D,1+

./%&($/./)#+'8+#D/+,)8/$,'$+W/)%+1%W%+%&+%+>$/*,1#'$+'8+&D'1A+,)+#$%(.%+>%#,/)#&4+

Emergency Radiology+:;;Qi+14(3)_+6R6?6RH4++

:H4++ ^//)%)+9C4+!&/+'8+("#$%&'()*+#'+>"%1/+1/)#$%"+",)/&4+f'($)%"+'8+7$,#,1%"+7%$/+:;;:i6Q+++++

++++++N:O+_6:PU5Q++

:P4+ M/()0+fV+`(882+3V+E,)1AD+F4+S/%"?G,./+!"#$%&')'0$%>D,1%""2?L(,*/*+I)#/$)%"+f(0("%$+

J/,)+7%#D/#/$,g%#,')+,)+#D/+-./$0/)12+`/>%$#./)#+I)1$/%&/&+9(11/&&+S%#/&+%)*+

S/*(1/&+7'.>",1%#,')&_+F+S%)*'.,g/*V+C$'&>/1#,W/+9#(*24+F))%"&+'8+-./$0/)12+

3/*,1,)/4+:;;PiKRNHO_HK;?HKQ4+

+

+

58

:Q4 c%#,')%"+I)&#,#(#/+8'$+7",),1%"+-T1/""/)1/4+L(,*%)1/+')+#D/+(&/+'8+("#$%&'()*+"'1%#,)0++

*/W,1/&+8'$+>"%1,)0+1/)#$%"+W/)'(&+1%#D/#/$&4+M')*')_+cI7-V+:;;:V+ucI7-+G/1D)'"'02+

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59

http://www.collemergencymed.ac.uk/CEM/Training%20and%20Examinations/Training/Ultrasound%20training

http://www.collemergencymed.ac.uk/CEM/Training%20and%20Examinations/Training/Ultrasound%20training

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+

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Acknowledegments:

+

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+

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+

+

60

Appendix 1 – Scanning log, summary of cases and reflective learning NGD$//+@"%)A+>%0/&+8'""'B+8'$+&1%)),)0+$/1'$*&V+>/$&')%"+)'#/&+%)*+$/8"/1#,W/+

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61

62

63

Appendix 2

!

Emergency Medicine Ultrasound

Core (Level 1) competency

Workplace Based Triggered Assessment @ 2010

Before using this document, a trainee should have completed a suitable theory course or series of modules, and received hands@on instruction. They should then have carried out supervised practice with maintenance of a log.

This document covers all workplace based assessments in level 1 (ie Focussed Assessment of the Abdominal Aorta, FAST, Ultrasound assisted Vascular Access, and Echo in Life Support) and is to be used alongside a training log.

When trainees are confident that they are ready for a formal assessment, the relevant section of the document is completed by an assessor who watches an actual patient scan. When each section is successfully completed, the whole document forms proof of achieving competency.

!

2

Trainee!information,!theory!training!and!log!summary!!

Theoretical and hands/on training To cover basic theory

o All 6 Enlightenme sessions completed (Indications, Physics, Image acquisition, FAST, Aortic assessment and Vascular access)

And/Or to cover basic practice

o CEM approved course, OR local modular training

Certified as complete by ______________________ (signed by above named Trainer) Date completed _________________________________________________ Logged Experience Evidence provided of scans carried out. Follow up notes and reflective writing on 10 case studies. Certified as complete by ______________________ (signed by above named Trainer) Date completed _________________________________________________________

!

Year EMUS training started: ��

School or Deanery: Regional EMUS Co9ordinator:

Trainer:

CT / HST / Non9training / Post CCT (circle)

3

Section A �Triggered Assessment in Focused Assessment of the Aorta!Date Location

Within each of the following three sections, the learner must:

Medical assessor�s comments recorded during the assessment

Competent?

1. Preparation for the scan Greets the patient appropriately and identifies the patient with the notes

Confirms that the indication for the procedure is within own competency

Positions the patient correctly

Demonstrates appropriate attitude and professional manner

2. The scan Sets up the equipment acceptably

o Patient details o Body marker insertion

Probe selection, handling and scanning technique

Acquisition of the best possible image Identifies IVC and Aorta in LS and TS Identifies SMA Measures AP diameter of aorta accurately

Timelines o Knows when to scan o Speed of scan

Saves/prints

3. Post scan Informs the patient appropriately

Makes a record of the findings

Knows if a repeat scan would be useful

4

Section B �Triggered Assessment in FAST Date Location


�� recorded during the assessment

Competent?








Acquisition of the best possible image: �� Demonstrates the spleno-renal interface Demonstrates potential fluid in the pelvis Demonstrates pericardial views Demonstrates the pleural space and can identify fluid

Timelines o Knows when to scan o Speed of scan

Saves/prints



Interprets and reports findings appropriately

Knows if a repeat scan would be useful

5

Section C �Triggered Assessment in Vascular Access Date Location

Within each of the following three sections,

the learner must: ��

recorded during the assessment Competent?








Acquisition of the best possible image Demonstrates the internal jugular vein Demonstrates a peripheral vein Indicates the technique to cannulate (may be ultrasound assisted or guided if peripheral)

Timelines o Speed of scan

Saves/prints




Indicates if a CXR is needed (ie in CV access)

6

Section D � Echo in Life Support Date Location


�� recorded during the assessment

Competent?








Acquisition of the best possible image: Demonstrates subxiphoid view plus one other cardiac view (eg long axis parasternal) Identifies pericardial space and any fluid that is present. Identifies presence / absence of ventricular wall motion, globally and focal. Comments appropriately on right and left ventricular size and can decide if RV dilated. Identifies IVC in LS. Assesses IVC diameter and collapsibility.

Timelines o Speed of scan

Saves/prints




Indicates if a CXR is needed (ie in CV access)

7

Summary (a) Competent to

scan and interpret findings independently

(b) Needs Supervision. If scanning alone cannot rely on findings

(c) Not competent at this stage

Signed and dated

Assessment of the abdominal aorta

FAST

Vascular access

Echo in Life Support

Once (a) has been achieved in all four areas, final sign �off can occur. If not, advice from trainer: _____________________________________________________________

FINAL SIGN-OFF Trainee name in print ____________________________________________________ This doctor is certified as competent in Level 1 Emergency Medicine Ultrasound, as defined by the College of Emergency Medicine, having undergone theoretical and practical training and demonstrated competency in all required areas. Signed by:

Regional Ultrasound Co-ordinator (print name/ sign) ________________________ Date _________________ Further advice _________________________________

______________________________________________________________________

CEM EMUS Level 1 WBA. Written by CEM Ultrasound Subgroup, Revision 2010. Adapted from de Cossart and Fish 2005©

71

Authors Editor and overall author

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Contributing Authors

Heather Venables, CFEU

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Paul Atkinson FCEM, CFEU

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Jim Connelly FCEM, CFEU

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John Wright FCEM, CFEU

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Russell McLaughlin FCEM, CFEU

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Bob Jarman FCEM, CFEU

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